Surgical treatment sf epilepsy in tuberous sclerosis - Strategies and results in 18 patients
Surgical treatment sf epilepsy in tuberous sclerosis - Strategies and results in 18 patients
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DOI：
10.1212/wnl.51.5.1263
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发表时间：
1998-11-01
期刊：
影响因子：
9.9
通讯作者：
Rasmussen, T
中科院分区：
文献类型：
--
作者：
Guerreiro, MM;Andermann, F;Rasmussen, T
背景：结节性硬化症(TSC)患者的癫痫发作通常对抗癫痫药物难以治愈，搜索研究可能会提供证据表明可以考虑手术治疗。目的：回顾研究和外科治疗的结果，这是一种通常不被认为是内科难治性癫痫和TSC患者的治疗方式。方法：我们报告了18例(9名男性)经手术治疗的难治性癫痫。12例癫痫灶定位良好，行病灶切除或局灶性切除。手术切除额叶7例，额叶4例，额叶1例，枕叶1例，额顶1例。4名患者接受了一次以上的手术。6例患者接受了穹隆切开术。结果：术后随访1个月至47年。切除组优7例，良1例，可3例，失访1例。尽管患者可能有多种癫痫发作类型、其他影像异常以及多灶性或全身性脑电表现，但有局灶性癫痫发作且影像与脑电相关性良好的患者可获得最佳结果。当没有这种相关性时，CC被发现是一种选择，因为五名患者至少有一些改善，只有一名患者没有变化。结论：手术治疗TSC合并顽固性癫痫最有效的方法是将单个结节或致痫区域确定为癫痫发作源并切除。即使当存在其他结节或弥漫性脑电异常时，这也是可能的。对于不能定位的癫痫异常的患者，CC可获得缓解。
Background: Seizures in patients with tuberous sclerosis complex (TSC) are often intractable to antiepileptic medications and searching investigation may provide evidence that surgical treatment can be considered. Objective: To review the results of investigation and surgical therapy, a treatment modality not generally considered in patients with medically refractory seizures and TSC. Methods: We report 18 patients (9 male) with TSC who underwent surgical treatment of medically refractory epilepsy. Twelve patients had a well-localized epileptogenic lesion and were treated by lesionectomy or focal resection. Resections were: 7 frontal, 4 temporal, 1 frontotemporal, 1 occipital, and I frontoparietal. Four patients underwent more than one operation. Six patients had corpus callosotomy (CC). Results: Follow-up ranged from 1 month to 47 years. Outcome of the patients treated by resection was excellent in 7 (5 were seizure-free and 2 had auras only), good in 1, fair in 3, and 1 was lost to follow-up. Best outcome was obtained in patients who had focal seizures and good imaging and EEG correlation, although they might have multiple seizure types, other imaging abnormalities, and multifocal or generalized EEG findings. When there was no such correlation, CC was found to be an option as five patients had at least some improvement and only one showed no change. Conclusion: Surgical treatment of patients with TSC and intractable epilepsy is most effective when a single tuber or epileptogenic area can be identified as the source of seizures and resected. This may be possible even when other tubers or diffuse EEG abnormalities are present. In patients with unlocalizable epileptic abnormalities, palliation may be obtained by CC.