Dysembryoplastic neuroepithelial tumors An MRI-based scheme for epilepsy surgery
Dysembryoplastic neuroepithelial tumors An MRI-based scheme for epilepsy surgery
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DOI：
10.1212/wnl.0b013e31826e9aa9
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发表时间：
2012-10-01
期刊：
影响因子：
9.9
通讯作者：
Devaux, Bertrand
中科院分区：
文献类型：
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作者：
Chassoux, Francine;Rodrigo, Sebastian;Devaux, Bertrand
目的：探讨胚胎发育不良神经上皮性肿瘤(DNT)3种组织亚型(单纯、复杂和非特异性)的最佳MRI表现。方法：78例DNT手术患者的MRI表现分为：1型(囊性/多囊样，轮廓清楚，高信号T1)，2型(结节样，不均匀)，3型(发育不良样，等/低信号T1，边界不清，灰白质模糊)。每种MRI亚型的组织学、神经生理学表现和手术结果之间建立了相关性。结果：I型MRI(25例，位于颞叶和颞外)总是对应于简单或复杂的DNTs。2型MRI(25例，主要位于新皮质)和3型(28例，主要位于内侧颞叶)对应于非特异性形式。不同核磁共振亚型的致痫灶(EZ)有显著差异(p=0.0029)。在1型MRI上与肿瘤共定位，在2型MRI上累及病灶周围皮质，在3型MRI上累及广泛区域。皮质发育不良主要见于3型磁共振(p<；0.0001)。完全切除肿瘤(p<；0.0001)和切除EZ(p=0.0115)是影响癫痫缓解效果(83%)的主要预后因素。其他有利影响预后的因素包括癫痫持续时间短(p=0.013)和切除部位无皮质-皮质下损伤(p=0.053)。手术年龄与预后无关；然而，皮质-皮质下损伤与老年相关(p=0.021)。停止治疗与手术年龄小(p=0.004)和癫痫病程短(p=0.001)有关。结论：我们建议手术切除可能仅限于1型的肿瘤，而在其他类型的mri中则更为广泛，尤其是3型的mri。早期手术和干净的手术切缘是治愈癫痫的关键。神经病学(R)2012；79：1699-1707
Objective: To determine optimal resections in the 3 dysembryoplastic neuroepithelial tumor (DNT) histologic subtypes (simple, complex, and nonspecific) based on MRI features.Methods: In 78 consecutive epilepsy patients operated for DNT, MRI features were classified as follows: type 1 (cystic/polycystic-like, well-delineated, strongly hypointense T1), type 2 (nodular-like, heterogeneous), or type 3 (dysplastic-like, iso/hyposignal T1, poor delineation, gray-white matter blurring). Correlations between histology, neurophysiologic findings, and surgical outcome were established for each MRI subtype.Results: Type 1 MRI (25 cases, in temporal and extratemporal areas) always corresponded to simple or complex DNTs. Type 2 MRI (25 cases, predominantly in neocortical areas) and type 3 MRI (28 cases, mainly in the mesial temporal lobe) corresponded to nonspecific forms. The epileptogenic zone (EZ) differed significantly according to the MRI subtype (p = 0.0029). It colocalized with the tumor in type 1 MRI, included perilesional cortex in type 2 MRI, and involved extensive areas in type 3 MRI. Cortical dysplasia was predominantly found in type 3 MRI (p < 0.0001). The main prognostic factors for seizure-free outcome (83%) were complete tumor (p < 0.0001) and EZ (p = 0.0115) removal. Other factors favorably influencing the outcome were a short epilepsy duration (p = 0.013) and absence of cortical-subcortical damage at the resection site (p = 0.053). Age at surgery was not related to outcome; however, cortical-subcortical damage was correlated with old age (p = 0.021). Treatment discontinuation was correlated with young age at surgery (p = 0.004) and short epilepsy duration (p = 0.001).Conclusion: We propose that resection might be restricted to the tumor in type 1 MRI and be more extensive in other MRI subtypes, especially in type 3 MRI. Early surgery and clean surgical margins are crucial for curing epilepsy. Neurology (R) 2012; 79: 1699-1707