Posterior quadrantic epilepsy surgery: Technical variants, surgical anatomy, and case series
Posterior quadrantic epilepsy surgery: Technical variants, surgical anatomy, and case series
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DOI：
10.1111/j.1528-1167.2007.01095.x
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发表时间：
2007-08-01
期刊：
影响因子：
5.6
通讯作者：
Villemure, Jean-Guy
中科院分区：
文献类型：
--
作者：
Daniel, Roy Thomas;Meagher-Villemure, Kathleen;Villemure, Jean-Guy
目的：由于累及后象限（颞叶、顶叶和枕叶）的广泛病变导致的难治性癫痫患者形成了癫痫手术的一个小子集。本研究旨在分析我们在这组患者中的经验，并确定过去15年来手术技术的变化。我们还描述了显微外科技术的不同的手术变种，沿着他们的功能neuroanatomic.Methods：在这个系列中有13例患者的中位年龄为17岁。所有患者均进行了广泛的术前评估，提供了一致的证据，将病变和癫痫灶定位于后象限。手术的目的是消除致痫组织的影响，并保留运动和感觉functions.Results：在本研究期间的15年的过程中，手术过程中进行演变，将更多的技术断开和尽量减少切除。因此，在该系列中使用了三种技术变体，即（i）解剖性后象限切除术（APQ），（ii）功能性后象限切除术（FPQ）和（iii）岛周后象限切除术（PIPQ）。经过6年的中位随访期，12/13例患者有恩格尔的I类癫痫outcome.Conclusion：手术后象限癫痫的结果取得了良好的癫痫发作的结果，在92%的患者在该系列中没有死亡率或主要发病率。在多叶手术中结合分离技术保持了早期切除手术获得的良好结果。
Objective: Patients with intractable epilepsy due to extensive lesions involving the posterior quadrant (temporal, parietal, and occipital lobes) form a small subset of epilepsy surgery. This study was done with a view to analyze our experience with this group of patients and to define the changes in the surgical technique over the last 15 years. We also describe the microsurgical technique of the different surgical variants used, along with their functional neuroanatomy.Methods: In this series there were 13 patients with a median age of 17 years. All patients had extensive presurgical evaluation that provided concordant evidence localizing the lesion and seizure focus to the posterior quadrant. The objective of the surgery was to eliminate the effect of the epileptogenic tissue and preserve motor and sensory functions.Results: During the course of this study period of 15 years, the surgical procedure performed evolved toward incorporating more techniques of disconnection and minimizing resection. Three technical variants were thus utilized in this series, namely, (i) anatomical posterior quadrantectomy (APQ), (ii) functional posterior quadrantectomy (FPQ), and (iii) periinsular posterior quadrantectomy (PIPQ). After a median follow-up period of 6 years, 12/13 patients had Engel's Class I seizure outcome.Conclusion: The results of surgery for posterior quadrantic epilepsy have yielded excellent seizure outcomes in 92% of the patients in the series with no mortality or major morbidity. The incorporation of disconnective techniques in multilobar surgery has maintained the excellent results obtained earlier with resective surgery.