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目的研究致癇性局灶性皮层发育不良(focal cortical dysplasia,FCD)的临床特点及外科手术治疗的疗效。方法对2004-01/2011-10月两所医院癫癇病灶切除术后病理证实为局灶性脑皮层发育不良患者的临床资料进行回顾性分析,总结其中各类临床资料完整的67例患者的病灶位置、病理亚型、磁共振成像(magnetic resonance imaging,MRI)特点、预后等指标,分析其相互关系。结果本组颅脑MRI阳性表现者45例,主要表现为灰白质交界不清、局部皮层增厚和形态异常、T2 WI与液体衰减反转恢复(fluid-attenuated inversion-recovery,FLAIR)像上白质信号增高等特点。其中T2、FLAIR高信号在FCDⅡb型中非常常见,而FCD I型中则少见。按照Engel预后分级法,本组Ⅰ级73.1%(49/67),Ⅱ级18.0%(12/67),Ⅲ级6.0%(4/67),Ⅳ级3.0%(2/67)。结论致癇性FCD病例MRI主要表现为灰白质交界不清、局部皮层增厚和形态异常、T2 WI与FLAIR像上白质信号增高等特点,手术治疗可达到较好疗效。
Objective To study the clinical characteristics of focal cortical dysplasia (FCD) and the curative effect of surgical treatment. Methods The clinical data of patients with pathologically confirmed focal cortical dysplasia after resection of epilepsy in the two hospitals from January 2004 to October 2011 were retrospectively analyzed. The clinical data of 67 patients with complete clinical data were summarized Location, pathological subtypes, magnetic resonance imaging (MRI) features, prognosis and other indicators, analysis of their relationship. Results The brain MRI manifestations in this group were 45 cases, the main manifestations of gray-white matter unclear junction, local cortical thickening and abnormal morphology, T2 WI and fluid attenuation attenuated recovery (fluid-attenuated inversion-recovery, FLAIR) Signal increases and so on. T2, FLAIR high signal in FCD Ⅱ b type is very common, while FCD I type is rare. According to the Engel prognostic classification, grade Ⅰ 73.1% (49/67), grade Ⅱ 18.0% (12/67), grade Ⅲ 6.0% (4/67), grade Ⅳ 3.0% (2/67). Conclusions The main manifestations of epileptic FCD are gray matter, unclear junction, local cortical thickening and morphological abnormalities. T2WI and FLAIR are characterized by increased white matter signal. Surgical treatment can achieve good effect.