Factors associated with failed focal neocortical epilepsy surgery.
Factors associated with failed focal neocortical epilepsy surgery.
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与局灶性新皮质癫痫手术失败有关的因素。
DOI：
10.1227/neu.0000000000000530
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发表时间：
2014-12
期刊：
影响因子：
4.8
通讯作者：
Chang EF
中科院分区：
文献类型：
--
作者：
Englot DJ;Raygor KP;Molinaro AM;Garcia PA;Knowlton RC;Auguste KI;Chang EF
局灶性新皮质癫痫（FNE）手术后的癫痫发作结局不如颞叶切除术后，手术失败的原因尚不完全清楚。很少有小组对癫痫复发进行深入检查，以确定失败的可能原因。阐明导致FNE手术失败的因素。我们回顾了1998年至2011年期间在我们机构进行的耐药FNE切除术。我们对癫痫预后预测因子进行了定量分析，并对手术失败病例进行了详细的定性分析。在125例FNE患者的138例切除术中，91例（66%）未发生致残性癫痫发作（Engel I结局）。平均± SEM患者年龄为20.0 ± 1.2岁;平均随访时间为3.8年（范围：1-17年）; 57%的患者为男性。不太有利（Engel II-IV）癫痫发作结局由术前癫痫发作频率较高预测（比值比= 0.85; 95%置信区间，0.78-0.93），全身强直阵挛发作史（比值比= 0.42; 95%置信区间，0.18-0.97）和正常磁共振成像（比值比= 0.30; 95%置信区间，0.09-1.02）。在检查的36例手术失败中，26例（72%）与切除范围有关，在切除边缘有残留癫痫灶，而10例（28%）涉及切除部位，有额外的致痫区远离切除。在癫痫复发后接受再次手术的16例患者中，10例（63%）实现了癫痫发作消失。切除范围不足是FNE手术后复发性癫痫发作的最常见原因，尽管有些患者具有远处癫痫病灶。许多癫痫控制不完全的患者都需要再次手术。
Seizure outcomes after focal neocortical epilepsy (FNE) surgery are less favorable than after temporal lobectomy, and the reasons for surgical failure are incompletely understood. Few groups have performed an in-depth examination of seizure recurrences to identify possible reasons for failure. To elucidate factors contributing to FNE surgery failures. We reviewed resections for drug-resistant FNE performed at our institution between 1998 and 2011. We performed a quantitative analysis of seizure outcome predictors and a detailed qualitative review of failed surgical cases. Of 138 resections in 125 FNE patients, 91 (66%) resulted in freedom from disabling seizures (Engel I outcome). Mean ± SEM patient age was 20.0 ± 1.2 years; mean follow-up was 3.8 years (range, 1-17 years); and 57% of patients were male. Less favorable (Engel II-IV) seizure outcome was predicted by higher preoperative seizure frequency (odds ratio = 0.85; 95% confidence interval, 0.78-0.93), a history of generalized tonic-clonic seizures (odds ratio = 0.42; 95% confidence interval, 0.18-0.97), and normal magnetic resonance imaging (odds ratio = 0.30; 95% confidence interval, 0.09-1.02). Among 36 surgical failures examined, 26 (72%) were related to extent of resection, with residual epileptic focus at the resection margins, whereas 10 (28%) involved location of resection, with an additional epileptogenic zone distant from the resection. Of 16 patients who received reoperation after seizure recurrence, 10 (63%) achieved seizure freedom. Insufficient extent of resection is the most common reason for recurrent seizures after FNE surgery, although some patients harbor a remote epileptic focus. Many patients with incomplete seizure control are candidates for reoperation.