| Objective:To explore the clinical characteristics,preoperative localization,postoperative efficacy and postoperative complications in patients with refractory epilepsy associated with encephalomalacia.Methods:The clinical data of 31 patients with refractory epilepsy related to encephalomalacia from July 2013 to March 2018 in the Epilepsy Center of the First Affiliated Hospital of Soochow University were analyzed retrospectively.Comprehensive preoperative evaluation was carried out according to clinical symptomatology,long-term video EEG(LTVEEG),magnetic resonance iamge(MRI),positron emission computed tomography(PET-CT),PET/MRI coregistration and so on.Local lesions/single lobe,multilobes or hemispherectomy were performed by the monitoring of electrocorticogram(ECoG)during the operation.Postoperative efficacy was graded according to Engel classification criteria.The quality of life(QOL)of epileptic patients was evaluated by QOLIE-10.SPSS22.0 was used for statistical analysis.Results:1.Among the causes of encephalomalacia in 31 cases,there were 11 cases(35.5%)with history of craniocerebral trauma;9 cases(29.0%)with history of ischemia and hypoxia;2 cases(6.5%)with history of intracranial surgery,including 1 case of glioma surgery,1 case of cyst surgery;2 cases(6.5%)with the history of intracranial hemorrhage;the etiology was unclear in 7 cases(22.6%).2.All 31 cases were focal epilepsy;1 case(3.2%)had focal seizure without disturbance of consciousness;10 cases(32.2%)had focal seizure with disturbance of consciousness;20 cases(64.5%)had secondary bilateral tonic-clonic seizures.3.There were 29 cases(93.5%)with unilateral lesions,2 cases(6.5%)with bilateral lesions;12 cases(38.7%)with single lobe lesions and 19 cases(61.3%)with multiple lobe lesions in 31 cases with MRI.Electroencephalogram(EEG)was discharged unilaterally in 15 cases(48.4%)and bilaterally in 16 cases(51.6%);and the onset of the seizure was consistent with the site of surgical resection.PET was unilateral hypometabolism in all 31 cases;single lobe hypometabolism in 12 cases(38.7%)and multilobe hypometabolism in 19 cases(61.3%).4.31 cases were followed up for 12 to 65 months after surgery,23 cases(74.2%)in grade ?,3 cases(9.7%)in grade ?,3 cases(9.7%)in grade ?,and 2 cases(6.5%)in grade?;The good prognosis rate was 83.9%;the overall effective rate was 93.5%.Among 19 cases with multiple cerebral lobe,14 cases(73.7%)in grade ?,2 cases(10.5%)in grade ?,2 cases(10.5%)in grade ?,and 1 case(5.3%)in grade ?;the good prognosis rate was 85.2%;the overall effective rate was 94.7%.There was no significant difference in the postoperative curative effect between the patients with multiple lobe and the patients with single lobe.There were 2 cases of bilateral imaging lesions,1 case of grade ? and 1 case of grade ? after operation.5.The quality of life of the patients after operation was significantly improved,and there was significant statistical difference compared with preoperative;The improvement of quality of life was more obvious in the non-seizure group compared to the seizure group,and there was a statistical difference between the two groups.6.Operative complications included intracranial infection in 4 cases,hydrocephalus in 2 cases;neurological complications including limb hemiplegia in 3 cases,visual field defect in 1 case;and no perioperative death.Permanent postoperative complications occurred in 4 cases(12.9%).Conclusion:1.Surgical treatment of refractory epilepsy associated with encephalomalacia has a good prognosis,significantly improving the quality of life of patients,and fewer complications.2.Accurate localization of epileptogenic foci is the key to good prognosis. |
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