Disconnective surgery in posterior quadrantic epilepsy: a series of 12 paediatric patients.
Disconnective surgery in posterior quadrantic epilepsy: a series of 12 paediatric patients.
复制标题
后象限癫痫的断开手术：一系列 12 名儿科患者。
DOI：
10.1684/epd.2014.0678
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Zhi
中科院分区：
文献类型：
--
作者：
Pengfan Yang;Zhen Mei;Q. Lin;Jiasheng Pei;Hui;Zhonghui Zhong;Jun Tian;Yanzeng Jia;Zi;Zhi
目的
评估颞顶枕（TPO）和顶枕（PO）分离手术治疗儿童难治性后象限癫痫和基于一侧TPO区域MRI和功能成像异常的单侧后象限病变的手术结果。
方法
对2009年9月至2012年9月期间接受TPO或PO分离手术的12名儿童的数据进行了回顾性分析。在手术过程中使用了MRI扫描的三维表面重建和术中电生理监测。所有患者术后均未停药。
结果
受影响的半球是7名患者的左侧和5名患者的右侧。癫痫发作和手术时的平均年龄分别为4岁和12.3岁。在手术时，3名儿童发生失张力性癫痫发作，4名儿童发生症状性癫痫伴局灶性癫痫发作和意识改变，4名儿童发生继发性全身性癫痫发作，1名儿童发生痉挛和强直性癫痫发作。所有患者均有发育迟缓。在11例患者中进行了纯TPO断开，在其余患者中进行了PO断开。病理检查显示3例为局灶性皮质发育不良（FCD）Ib，2例为FCD IIa，5例为FCD IIb，1例为胶质增生，1例为胶质增生+FCD IIa。术后，2例患者出现水肿; 1例患者需要再次手术切除枕叶。平均随访34.5个月时，9例患者（75%）被分类为Engel I级，2例为Engel II级，1例为Engel III级。所有12名儿童术后均出现对侧偏盲，术后3个月报告中位智商（p=0.04）改善。
结论
考虑到回顾性和相对较小样本量系列的限制，TPO和PO断开术在选定的癫痫样区位于一侧后象限的患者中是安全有效的保留运动神经的癫痫外科手术。
AIM
To assess the surgical outcomes of temporo-parieto-occipital (TPO) and parieto-occipital (PO) disconnection surgery for children with intractable posterior quadrantic epilepsy and a unilateral posterior quadrant lesion based on MRI and functional imaging abnormality in the TPO region on one side.
METHODS
A retrospective review of data of 12 children who underwent TPO or PO disconnective surgery was carried out from September 2009 to September 2012. Three-dimensional surface reconstructions of MRI scans and intraoperative electrophysiological monitoring were used during surgery. Drugs were not discontinued after surgery in any patient.
RESULTS
The affected hemisphere was the left in seven patients and the right in five patients. The mean ages at seizure onset and at surgery were four years and 12.3 years, respectively. At the time of surgery, 3 children had atonic seizures, 4 had symptomatic epilepsy with focal seizures and alteration of conscioussness, 4 had secondarily generalised seizures, and 1 child had spasms and tonic seizures. All patients had developmental delay. A pure TPO disconnection was performed in 11 patients and a PO disconnection was performed in the remaining patient. On pathological examination, 3 patients were shown to have focal cortical dysplasia (FCD) Ib, 2 with FCD IIa, 5 with FCD IIb, 1 with gliosis, and 1 with gliosis plus FCD IIa. Following surgery, 2 patients had oedema; 1 required another operation to resect the occipital lobe. At a mean follow-up of 34.5 months, 9 patients (75%) were classified as Engel class I, 2 as Engel Class II, and 1 as Engel class III. All 12 children had contralateral hemianopia postoperatively and improvement in median IQ (p=0.04) was reported three months postoperatively.
CONCLUSIONS
With respect to the limits of a retrospective and relatively small sample size series TPO and PO disconnection are safe and effective motor-sparing epilepsy surgical procedures in selected patients with the epileptiform zone located in the posterior quadrant on one side.