Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patients
Frontal disconnection surgery for drug‐resistant epilepsy: Outcome in a series of 16 patients
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治疗耐药性癫痫的额叶断路手术：16 名患者的结果
DOI：
10.1002/epi4.12424
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发表时间：
2020
期刊：
影响因子：
3
通讯作者：
Mashael Alkhateeb
中科院分区：
文献类型：
--
作者：
H. Kamalboor;H. Alhindi;F. Alotaibi;I. Althubaiti;Mashael Alkhateeb
摘要 目的 在一系列连续患者中评估额叶离断术在癫痫发作控制及相关后果方面的有效性。方法 我们对因耐药性癫痫（DRE）接受额叶离断术的患者进行了回顾性分析。回顾了基线癫痫特征、包括致痫区（EZ）定位在内的详细术前评估、磁共振成像（MRI）对致痫病灶的检测以及病理结果。术后对患者进行1年的癫痫发作结果随访。结果 共确定了16例患者（6例儿童和10例成人）。大多数患者在儿童时期发病，手术前癫痫中位病程为6.5年（四分位间距3.5 - 17.5年）。在10例（62.5%）患者中，致痫区定位在额叶，而在6例患者中，致痫区还涉及相邻脑叶或由多个病灶组成。在10例（62.5%）患者中，术前MRI检测到致痫病灶，其中4例（40%）的所有MRI异常均局限于额叶。三分之二的患者（11/16；68.8%）接受了单纯的额叶离断术，而其余患者则进行了额叶离断联合相邻脑叶切除。在从离断的额叶进行活检的12例患者中，6例（50%）有经病理证实的局灶性皮质发育不良。我们观察到3例（18.8%）出现手术相关并发症，另外3例（18.8%）患者出现神经功能缺损，1例（6.3%）患者认知能力恶化。总体而言，在1年随访时，8例（50%）患者完全无癫痫发作（国际抗癫痫联盟1级）。意义 对于DRE的额叶离断术可使某些患者无癫痫发作，特别是当致痫区严格局限于同侧额叶区域，且MRI显示致痫病灶完全位于额叶时。额叶离断术是安全的，并发症发生率有限。然而，对更大患者群体进行进一步研究将更有意义。
Abstract Objective To evaluate the effectiveness of frontal disconnection surgery in seizure control and related consequences in a consecutive patient series. Methods We conducted a retrospective analysis of patients who underwent frontal disconnection surgery for drug‐resistant epilepsy (DRE). Baseline epilepsy characteristics, detailed presurgical evaluation including epileptogenic zone (EZ) localization, magnetic resonance imaging (MRI) detection of epileptogenic lesion, and pathological findings were reviewed. Patients were followed postoperatively for seizure outcome at 1 year. Results A total of 16 patients were identified (six children and 10 adults). Most patients had a childhood onset of DRE with a median duration of epilepsy of 6.5 years (interquartile range 3.5‐17.5 years) before surgery. In 10 (62.5%) patients, the EZ was localized to the frontal lobe, while in six patients, the EZ involved also adjacent lobes or consisted of multiple foci. In 10 (62.5%) patients, an epileptogenic lesion was detected on presurgical MRI, four of which (40%) had all MRI abnormalities confined to the frontal lobe. Two‐thirds of the patients (11/16; 68.8%) underwent isolated frontal disconnection procedure, while remaining patients had frontal disconnection combined with resection of an adjacent lobe. Of the 12 patients in whom biopsy was taken from the disconnected frontal lobe, six (50%) had pathology‐proven focal cortical dysplasia. We observed surgical‐related complications in three (18.8%) cases, neurological deficits in other three (18.8%) patients, and worsening cognitive abilities in one (6.3%) patient. Overall, eight (50%) patients became completely seizure‐free (ILAE 1) at one‐year follow‐up. Significance Frontal disconnection surgery for DRE can result in seizure freedom in certain patients, especially when the EZ is strictly limited to the ipsilateral frontal region, and the MRI shows an epileptogenic lesion that is purely frontal in location. Frontal lobe disconnection procedure is safe and has a limited complication rate. However, further studies with larger patient population will yield more significance.