Surgical treatment of occipital lobe epilepsy
Surgical treatment of occipital lobe epilepsy
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DOI：
10.3171/jns/2008/109/7/0057
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发表时间：
2008-07-01
影响因子：
4.1
通讯作者：
Clusmann, Hans
中科院分区：
文献类型：
--
作者：
Binder, Devin K.;von Lehe, Marec;Clusmann, Hans
Object.枕叶癫痫（OLE）占颞外癫痫的一小部分，只有少数且大多数是小患者系列报告。OLE的术前发现、手术策略、组织病理学基础和术后结果仍有待阐明。从1989年建立的前瞻性癫痫手术数据库中确定了一组54例枕叶受累患者。病历，手术报告，磁共振成像，和组织病理学数据进行了审查，并与额外的颞叶和/或顶叶受累的患者进行了单独分类。根据Engel分类方案（I-IV类）对癫痫发作结局进行分类。2例患者因数据集不完整而被排除。52例以枕叶为主的难治性癫痫患者纳入研究，占292例颞外癫痫手术患者的17.8%。几乎所有病例（50/52 [96.2%]）术前MR成像均可见结构性病变。在这些病例中，29例（55.8%）为“纯”OLE，无颞叶或顶叶受累。大多数患者（83%）有复杂的部分性发作，60%也有全身性发作。所有患者均接受了枕叶病变切除术或顶叶切除术; 9例患者（17.3%）接受了额外的多次软膜下横切。组织学检查结果显示9例皮质发育不良（17.3%），9例神经节细胞胶质瘤（17.3%），6例其他肿瘤（11.5%），13例血管畸形（25%）和15例胶质瘢痕（28.8%）。36.4%的患者术前存在视野缺损，42.4%的患者术后出现新的或加重的视野缺损。平均随访80个月后，36例患者无癫痫发作（69.2% Engel I级），4例罕见癫痫发作（7.7% Engel II级），8例改善超过75%（15.4% Engel III级），4例无显著改善（7.7% Engel IV级）。多因素Logistic回归分析显示，癫痫发作时年龄越小（p = 0.031）和癫痫持续时间越短（p = 0.004），癫痫控制效果越好。所有其他临床和手术因素在预测预后方面均无显著性意义。枕叶癫痫是一种罕见的，但重要的原因颞外癫痫。在我们的系列中，77%的患者获得了满意的结果（Engel I级或II级）。术后视野缺损发生在一个显着的比例的患者。在现代MR成像时代，应检查OLE患者的病变，并尽早进行病变切除术，以获得更好的结果。
Object. Occipital lobe epilepsy (OLE) accounts for a small percentage of extratemporal epilepsies and only few and mostly small patient series have been reported. Preoperative findings, surgical strategies, histopathological bases, and postoperative outcomes for OLE remain to be elucidated.Methods. A group of 54 patients with occipital lobe involvement were identified from a prospective epilepsy surgery database established in 1989. Medical charts, surgical reports, MR imaging, and histopathology data were reviewed, and patients with additional temporal and/or parietal involvement were categorized separately. Seizure outcome was classified according to the Engel classification scheme (Classes I-IV). Two patients were excluded due to incomplete data sets. Fifty-two patients with intractable epilepsy involving predominantly the occipital lobe were included in the study, comprising 17.8% of 292 patients undergoing operations for extratemporal epilepsies.Results. In nearly all cases (50 [96.2%] of 52), a structural lesion was visible on preoperative MR imaging. Of these cases, 29 (55.8%) had "pure" OLE with no temporal or parietal lobe involvement. Most patients (83%) had complex partial seizures, and 60% also had generalized seizures. All patients underwent occipital lesionectomies or topectomies; 9 patients (17.3%) underwent additional multiple subpial transections. Histopathology results revealed 9 cortical dysplasias (17.3%), 9 gangliogliomas (17.3%), 6 other tumors (11.5%), 13 vascular malformations (25%), and 15 glial scars (28.8%). Visual field deficits were present in 36.4% of patients preoperatively, and 42.4% had new or aggravated visual field deficits after surgery. After a mean follow-up of 80 months, 36 patients were seizure free (69.2% Engel Class I), 4 rarely had seizures (7.7% Engel Class II), 8 improved more than 75% (15.4% Engel Class III), and 4 had no significant improvement (7.7% Engel Class IV). Multifactorial logistic regression analysis revealed that early age at epilepsy manifestation (p = 0.031) and shorter epilepsy duration (p = 0.004) were predictive of better seizure control. All other clinical and surgical factors were not significant in predicting outcome.Conclusions. Occipital lobe epilepsy is an infrequent but significant cause of extratemporal epilepsy. Satisfactory results (Engel Class I or II) were obtained in 77% of patients in our series. Postoperative visual field deficits occurred in a significant proportion of patients. In the modem MR imaging era, lesions should be investigated in patients with OLE and lesionectomies should be performed early for a better outcome.