Surgical management and seizure outcome in patients with tuberous sclerosis
Surgical management and seizure outcome in patients with tuberous sclerosis
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DOI：
10.3171/jns.1997.87.3.0391
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发表时间：
1997-09-01
影响因子：
4.1
通讯作者：
Ojemann, GA
中科院分区：
文献类型：
--
作者：
Avellino, AM;Berger, MS;Ojemann, GA
作者报告了在因难治性癫痫而接受皮质切除手术的结节性硬化症（TS）患者中获得的结果。患者手术时的年龄范围为 3 至 46 岁（平均 19.6 岁）。术前癫痫样脑电图异常为 6 名患者（55%）为局灶性棘波放电，4 名患者（36%）为多灶性，1 名患者（9%）为全身性。在多焦组和全身组中，所有患者（45%）均通过硬膜下网格和条状电极记录进行评估，而其余患者的电生理定位则来自发作期和发作间期头皮记录。 6 名患者 (55%) 的癫痫病灶位于颞外，5 名患者 (45%) 的癫痫病灶位于颞部。手术干预包括开颅手术和癫痫病灶切除术，在皮质电图监测和功能映射的指导下，对五名清醒患者（45%）和六名睡眠患者（55%）进行了手术干预。对切除的癫痫病灶进行神经病理学检查，发现八名患者存在皮质结节，三名患者存在弥漫性神经胶质增生。随访时间为 8 至 127 个月（平均 35 个月）。六名患者（55%）没有癫痫发作，其中一半没有接受抗癫痫药物（AED）；三名患者 (27%) 尽管需要 AED，但癫痫发作频率减少了 70% 以上；一名患者 (9%) 在术后最初 6 个月期间癫痫发作频率暂时减少了 50%；一名患者（9%）失访。从这一小规模但得到充分随访的 TS 患者群体中，作者得出结论，根据皮质电图结果和功能图谱定制癫痫病灶的皮质切除术，对于难以管理的难治性癫痫患者群体来说是令人鼓舞的。
The authors report the results obtained in Il patients with tuberous sclerosis (TS) who underwent cortical resection surgery for medically intractable epilepsy. Patients' ages at time of surgery ranged from 3 to 46 years (mean 19.6 years). Preoperative epileptiform electroencephalographic abnormalities were focal spike wave discharges in six patients (55%), multifocal in four patients (36%), and generalized in one patient (9%). In the multifocal and generalized groups, all patients (45%) were evaluated by means of subdural grid and strip electrode recordings, whereas electrophysiological localization in the remaining patients was derived from ictal and interictal scalp recordings. The seizure foci were found to be extratemporal in six patients (55%) and temporal in five patients (45%). Surgical intervention consisted of craniotomy and seizure foci resection guided by electrocorticographic monitoring and functional mapping in five awake (45%) and six asleep (55%) patients. Neuropathological examination of the resected seizure foci revealed cortical tubers in eight patients and diffuse gliosis in three patients. Follow up ranged from 8 to 127 months (mean 35 months). Six patients (55%) were seizure free, half of whom were not receiving antiepileptic drugs (AEDs); three patients (27%) had a greater than 70% reduction in seizure frequency, although they required AEDs; one patient (9%) had a 50% temporary reduction in seizure frequency during the initial 6-month postoperative period; and one patient (9%) was lost to follow-up study. From this small but adequately followed patient population with TS, the authors conclude that cortical resection of seizure foci tailored to electrocorticographic findings and functional mapping is encouraging for this difficult to manage patient population with medically intractable epilepsy.