Cerebral hemispherectomy - Hospital course, seizure, developmental, language, and motor outcomes
Cerebral hemispherectomy - Hospital course, seizure, developmental, language, and motor outcomes
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DOI：
10.1212/01.wnl.0000127109.14569.c3
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发表时间：
2004-05-25
期刊：
影响因子：
9.9
通讯作者：
Mathern, GW
中科院分区：
文献类型：
--
作者：
Jonas, R;Nguyen, S;Mathern, GW
目的：比较不同病理基础的半球切除术患者的住院过程、癫痫发作、发育、语言和运动结果。方法：作者将半脑切除术患者（115例）与半大脑畸形（16例）、半脑皮质发育不良（39例）、拉斯穆森脑炎（21例）、梗死/缺血（27例）和其他/杂项（12例）进行比较，以了解手术处理、术后癫痫发作控制和抗癫痫药物（AED）使用的差异。此外，Vineland适应行为量表（VABS）发育商（DQ）、语言和运动评估在术前或术后进行，或两者同时进行。结果：手术中，HME患者围手术期出血量最大，手术时间最长。术后1 ~ 5年无癫痫发作或未使用aed的HME患者较少，但病理组间差异无统计学意义。术后，66%的HME患者很少或没有语言，肢体麻痹的运动评分更差。相比之下，40%至50%的半CD患儿表现出接近正常的语言和运动评估，与RE和梗死/缺血病例相似。57%的患者术后VABS DQ评分改善+5分或以上，与RE（+4.6）和梗死/缺血（+0.6）病例相比，半CD（+12.7）和HME（+9.1）患儿的进展最大。术后VABS DQ评分与癫痫持续时间、癫痫控制和术前DQ评分相关。结论：病理基础预测了手术前后的结果差异，半巨脑畸形（但不是半球皮质发育不良）患者在几个方面表现更差。此外，更短的癫痫持续时间、癫痫控制和更大的手术前发育商数预示着所有患者手术后发育商数的改善，与病理无关。
Objective: To compare hemispherectomy patients with different pathologic substrates for hospital course, seizure, developmental, language, and motor outcomes. Methods: The authors compared hemispherectomy patients (n = 115) with hemimegalencephaly (HME; n = 16), hemispheric cortical dysplasia (hemi CD; n = 39), Rasmussen encephalitis (RE; n = 21), infarct/ ischemia (n = 27), and other/miscellaneous (n = 12) for differences in operative management, postsurgery seizure control, and antiepilepsy drug (AED) usage. In addition, Vineland Adaptive Behavior Scale (VABS) developmental quotients (DQ), language, and motor assessments were performed pre- or postsurgery, or both. Results: Surgically, HME patients had the greatest perioperative blood loss, and the longest surgery time. Fewer HME patients were seizure free or not taking AEDs 1 to 5 years postsurgery, but the differences between pathologic groups were not significant. Postsurgery, 66% of HME patients had little or no language and worse motor scores in the paretic limbs. By contrast, 40 to 50% of hemi CD children showed near normal language and motor assessments, similar to RE and infarct/ ischemia cases. VABS DQ scores showed +5 points or more improvement postsurgery in 57% of patients, and hemi CD (+12.7) and HME (+9.1) children showed the most progress compared with RE (+4.6) and infarct/ ischemia (+0.6) cases. Postsurgery VABS DQ scores correlated with seizure duration, seizure control, and presurgery DQ scores. Conclusions: The pathologic substrate predicted pre- and postsurgery differences in outcomes, with hemimegalencephaly (but not hemispheric cortical dysplasia) patients doing worse in several domains. Furthermore, shorter seizure durations, seizure control, and greater presurgery developmental quotients predicted better postsurgery developmental quotients in all patients, irrespective of pathology.