Cortical resection with electrocorticography for intractable porencephaly-related partial epilepsy
Cortical resection with electrocorticography for intractable porencephaly-related partial epilepsy
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DOI：
10.1111/j.0013-9580.2005.28704.x
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发表时间：
2005-01-01
期刊：
影响因子：
5.6
通讯作者：
Olivier, A
中科院分区：
文献类型：
--
作者：
Iida, K;Otsubo, T;Olivier, A
目的：评价皮质切除致痫组织治疗难治性多孔性癫痫的疗效。方法：对8例顽固性多孔性癫痫患者的临床表现、电生理资料、手术结果及术后癫痫转归进行分析。5例保留偏瘫肢体运动功能，6例保留视野。所有患者均有部分癫痫发作，6例有二次泛化发作。7名患者有单纯性发作，3名患者有复杂部分性癫痫(CPSS)；2名患者也有跌倒发作。4例患者有多种癫痫发作类型。长期头皮视频脑电(LVEEG)定位了三名患者癫痫发作间期的异常，解剖上与囊肿位相对应。LVEEG记录了5个发作区；在解剖学上，这些区域与5个中的3个的囊性位置相对应。脑电记录到2例全身性癫痫发作，1例为半球发作，2例为多灶性发作。术中皮层脑电图(ECoG)显示7例患者发作间期癫痫区域延伸至囊外。我们完全切除了5名患者的癫痫发作间期皮层脑区，部分切除了2名患者。1例ECoG未显示癫痫样放电的患者，根据癫痫症状和LVEEG行皮质切除。术后随访1年，6例癫痫发作恢复良好(Engel I级)，2例癫痫发作减少率达90%(Engel III级)，无并发症发生。结论：ECoG引导下皮质切除可保留运动功能和视野，为治疗继发于孔脑畸形的顽固性癫痫提供了一种有效的手术方法。
Purpose: We evaluated the results of cortical resection of epileptogenic tissue for treatment of intractable porencephaly-related epilepsy.Methods: We examined clinical features, electrophysiological data, surgical findings, and seizure outcomes after cortical resection in eight patients with intractable epilepsy related to porencephalic cysts.Results: All eight patients had hemiparesis. Five retained motor function in the hemiparetic extremities; six retained visual fields. All had partial seizures, six with secondary generalization. Seven patients had simple and three had complex partial seizures (CPSs); two also had drop attacks. Four patients had multiple seizure types. Long-term scalp video-EEG (LVEEG) localized interictal epileptic abnormalities that anatomically corresponded to the cyst location in three patients. LVEEG recorded ictal-onset zones in five; these anatomically corresponded to the cyst location in three of the five. EEG recorded generalized seizures in two patients, hemispheric in one, and multifocal in two. Intraoperative electrocorticography (ECoG) revealed interictal epileptic areas extending beyond the margins of the cyst in seven patients. We resected ECoG-localized interictal epileptic areas completely in five patients and partially in two. Cortical resection was based on seizure semiology and LVEEG in one patient whose ECoG showed no epileptiform discharges. After a minimum follow-up of 1 year, six patients had excellent seizure outcome (Engel class I), and two had a > 90 % seizure reduction (Engel class III) without complications.Conclusions: Cortical resection guided by ECoG allows preservation of motor function and visual field and provides an effective surgical procedure for treatment of intractable epilepsy secondary to porencephaly.