SURGERY FOR INTRACTABLE INFANTILE SPASMS - NEUROIMAGING PERSPECTIVES
SURGERY FOR INTRACTABLE INFANTILE SPASMS - NEUROIMAGING PERSPECTIVES
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DOI：
10.1111/j.1528-1157.1993.tb00459.x
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发表时间：
1993-07-01
期刊：
影响因子：
5.6
通讯作者：
PEACOCK, WJ
中科院分区：
文献类型：
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作者：
CHUGANI, HT;SHEWMON, DA;PEACOCK, WJ
23名婴儿和儿童因难治性婴儿痉挛接受了皮质切除术（n = 15）或半球切除术（n = 8）。23例患者中有17例在手术时出现婴儿痉挛；在6例中，痉挛在手术评估期间演变为其他癫痫发作类型。有婴幼儿痉挛病史的儿童被排除在本研究之外。7例患儿通过磁共振成像发现局灶性或半球病变；另外2例表现为局灶性萎缩，无离散病变。正电子发射断层扫描（PET）显示所有患者脑葡萄糖利用的偏侧或局部异常；14例病例中，PET是识别致癫痫皮质的唯一神经成像方式。当这种情况发生时，切除脑组织的神经病理学检查通常显示畸形和发育不良的皮质病变。所有患者均出现局灶间期和/或间期电图异常，与神经影像学定位吻合良好。所有患者均未接受颅内电极慢性侵入性电监测。在随访期间（4-67个月，平均28.3个月），15名患儿无癫痫发作，3名患儿癫痫发作控制90%，1名患儿癫痫发作控制75%，4名患儿癫痫发作频率未从手术中获益。
Twenty-three infants and children underwent cortical resection (n = 15) or hemispherectomy (n = 8) for intractable infantile spasms. Infantile spasms were present at the time of surgery in 17 of the 23 patients; in six, spasms had evolved to other seizure types during surgical evaluation. Children with a remote history of infantile spasms were excluded from this study. Focal or hemispheric lesions were identified by magnetic resonance imaging in seven children; an additional two showed focal atrophy without a discrete lesion. Positron emission tomography (PET) showed lateralized or localized abnormalities of cerebral glucose utilization in all patients; in 14, PET was the only neuroimaging modality to identify the epileptogenic cortex. When this occurred, neuropathological examination of resected brain tissue typically showed malformative and dysplastic cortical lesions. Focal interictal and/or ictal electrographic abnormalities were present in all patients, and corresponded well with localization from neuroimaging. None of the patients were subjected to chronic invasive electrographic monitoring with intracranial electrodes. At follow-up (range 4-67 months; mean 28.3 months), 15 children were seizure-free, three had 90% seizure control, one had 75% seizure control, and four failed to benefit from surgery with respect to seizure frequency.