Additional resective surgery after the failure of initial surgery in patients with intractable epilepsy
Additional resective surgery after the failure of initial surgery in patients with intractable epilepsy
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DOI：
10.1080/01616412.2017.1376471
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发表时间：
2017-12-01
影响因子：
1.9
通讯作者：
Fujii, Yukihiko
中科院分区：
文献类型：
--
作者：
Fukuda, Masafumi;Masuda, Hiroshi;Fujii, Yukihiko
目的：难治性癫痫切除手术失败的原因可能有三种：致痫区包括或重叠功能区切除不完全（A组）;首次手术前致痫区判断不正确（B组）;首次手术后形成新的致痫灶（C组）。我们研究了初次手术失败的原因和患者的结果之间的关系后，重复surgical surgery.Methods：本研究包括18例（5.1%）进行了额外的手术失败后的初次手术。结果：A组4例（22.2%），B组13例（72.2%），C组1例（5.6%）。6例患者（40.0%）在再次手术后2年或更长时间内无复发。在B组中，11名患者接受了邻近先前切除区域的皮质的额外切除，2名患者接受了涉及远离先前切除区域的部位的再次手术;值得注意的是，后2名患者术后未达到无皮质状态。第一次手术后，只有1例患者（A组）出现短暂性麻痹;再次手术后，18例患者中有10例（56%; A组3例，B组6例，C组1例）出现各种并发症。虽然额外的切除手术使约40%的患者免于癫痫发作，在考虑额外手术时，重要的是要权衡并发症的高风险与可能的益处。
Objectives: There are three conceivable reasons for the failure of resective surgery for intractable epilepsy: incomplete resection of the epileptogenic zone including or overlapping with eloquent area (group A); incorrect determination of the epileptogenic zone prior to the first surgery (group B); and the development of a new epileptic focus after the first surgery (group C). We examined the relationship between the reason for failure of initial surgery and patient outcomes after repeated surgical resection.Methods: The study included 18 patients (5.1%) underwent additional surgery after failure of the initial operation. Post-operative outcomes, complications and other clinical data were collected by retrospective chart review.Results: Four patients (22.2%) were assigned to group A, 13 (72.2%) were assigned to group B, and 1 patient was assigned to group C (5.6%). Six patients (40.0%) were seizure-free for 2 or more years after additional surgery. In group B, 11 patients underwent additional resection of the cortex adjacent to the previously resected area and 2 underwent re-operation involving a site distant from the previously resected area; notably, the latter 2 patients did not achieve seizure-free status post-surgery. After the first operation, only one patient (group A) experienced transient paresis; after additional surgery, 10 of 18 patients (56%; 3 group A, 6 group B, and 1 group C) experienced various complication.Discussion: Although additional resective surgery provided freedom from seizures in about 40% of the patients, it is important to weigh a high risk of complications against possible benefits when considering additional surgery.