Retrospective analysis of variables favouring good surgical outcome in posterior epilepsies
Retrospective analysis of variables favouring good surgical outcome in posterior epilepsies
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DOI：
10.1007/s00415-005-0676-4
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发表时间：
2005-04-01
影响因子：
6
通讯作者：
Colicchio, G
中科院分区：
文献类型：
--
作者：
Barba, C;Doglietto, F;Colicchio, G
目的探讨影响后部癫痫手术疗效的因素。方法对14例接受癫痫手术的患者进行研究。经侵袭性和非侵入性手术前评估，致痫区域位于颞顶枕区。比较几个变量(首次发作年龄；手术年龄；病程；癫痫类型、发作频率和临床症状学；有无病变；头皮发作期和发作间期脑电波；致痫区域的定位和扩展；手术切除的完成性)与无癫痫发作的情况进行比较，以确定手术结果(Engel分级)是否与其中任何一项有关。结果7例无癫痫发作(Ia)，3例(Ib 2例，Ic 1例)效果满意。术后仅有3例患者出现新的视力障碍。手术结果与两个变量显著相关：头皮发作期脑电(局灶性与非局灶性；p：0.014)和致痫区手术切除的完成性(p：0.0023)。发现局灶性发作间颅内活动较非局灶性发作间期活动有更好预后的显著趋势(p：0.07)。结论致痫灶切除的完全性与手术结果的相关性提示，术前准确确定致痫灶切除范围，有助于获得更满意的治疗效果。
Aim to determine variables favouring good surgical outcome in posterior epilepsies. Methods Fourteen patients submitted to epilepsy surgery were included in the study. The epileptogenic zone was located in temporo-parieto-occipital areas as assessed by both invasive and non-invasive pre-surgical evaluation. Several variables ( age at first seizure; age at surgery; disease duration; type, frequency and clinical semiology of seizures; presence of lesion; scalp ictal and interictal EEG; localization and extension of epileptogenic zone; completeness of surgical resection) were compared ( Fisher's exact test) with freedom from seizures to determine whether surgical outcome (Engel's classification) could be related to any of them. Results Seven patients were seizure free (Ia) and very satisfying results were obtained for 3 patients ( 2 Ib, 1 Ic). New post-surgical visual deficits occurred only in 3 patients. Surgical outcome was related significantly to two variables: scalp ictal EEG ( focal versus non-focal; p: 0.014) and completeness of surgical resection of epileptogenic zone ( p: 0.0023). A significant trend towards a better outcome for focal interictal intracranial activity versus a nonfocal one ( p: 0.07) was found. Conclusions The correlation between completeness of epileptogenic zone resection and surgical outcome suggests that a presurgical protocol, allowing a precise definition of the area of resection, could help in obtaining more satisfying results in posterior epilepsies.