Multistage epilepsy surgery: Safety, efficacy, and utility of a novel approach in pediatric extratemporal epilepsy
Multistage epilepsy surgery: Safety, efficacy, and utility of a novel approach in pediatric extratemporal epilepsy
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DOI：
10.1227/01.neu.0000148908.71296.fa
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发表时间：
2005-02-01
期刊：
影响因子：
4.8
通讯作者：
Weiner, HL
中科院分区：
文献类型：
--
作者：
Bauman, JA;Feoli, E;Weiner, HL
目的：评价一种新型手术策略的安全性、有效性和实用性，（两个以上）手术阶段在同一家医院入院期间进行的硬膜下网格和条形电极在选定的小儿颞外癫痫。应用硬膜下格栅电极和条形电极对15例小儿进行多阶段慢性脑电图监测（年龄< 19岁）有难治性局部相关性癫痫和较差的手术治疗因素。初步切除手术和/或多软膜下横切进行，随后进一步监测和额外的切除和/或多软膜下transsections.Results：平均患者年龄为9.7岁。总侵入性监测的平均持续时间为10.5天（范围，8 - 14天）。第一个监测期平均为6.5天，第二个监测期平均为3.9天。15例患者中有13例进行了额外手术。2例未接受额外手术的患者的结局为I类。重新调查的原因包括不完全定位、多灶性和接近功能区皮质。并发症很小，包括两次输血。无伤口感染、脑水肿、出血或严重永久性神经功能缺损病例。最短随访时间为31个月。结局为60% Engel I级（9或15例患者）、27% III级（4/15例患者）和13% IV级（2/15例患者）。结论：在具有不良手术预后因素的非常精选的儿科患者组中，多阶段方法可能有益。在癫痫手术失败后，当怀疑有单个残留病灶时，传统上使用后续的再手术和额外的颅内检查。然而，我们的研究结果支持这样的论点，即多阶段癫痫手术在具有挑战性和选择性的颞外难治性癫痫儿童人群中是安全、有效和有用的。
Objective: To evaluate the safety, efficacy, and utility of a novel surgical strategy consisting of multiple (more than two) operative stages performed during the same hospital admission with subdural grid and strip electrodes in selected pediatric extra-temporal epilepsy.Methods: Subdural grid and strip electrodes were used for multistage chronic electroencephalographic monitoring in 15 pediatric patients (age, < 19 yr) with refractory localization-related epilepsy and poor surgical prognositic factors. Initial resective surgery and/or multiple subpial transections were performed, followed by further monitoring and additional resection and/or multiple subpial transections.Results: Mean patient age was 9.7 years. Mean duration of total invasive monitoring was 10.5 days (range, 8 - 14 d). The first monitoring period averaged 6.5 days, and the second averaged 3.9 days. Additional surgery was performed in 13 of 15 patients. Two patients who did not undergo additional surgery had a Class I outcome. Rationales for reinvestigation included incomplete localization, multifocality, and proximity to eloquent cortex. Complications were minimal, including tow transfusions. There were no cases of wound infection, cerebral edema, hemorrhage, or major permanent neurological deficit. Minimum duration of follow-up was 31 months. Outcomes were 60% Engel Class I (9 or 15 patients), 27% Class III (4 of 15 patients), and 13% Class IV (2 of 15 patients)Conclusion: In a very select group of pediatric patients with poor surgical prognostic factors, the multistage approach can be beneficial. After failed epilepsy surgery, subsequent reoperation with additional intracranial investigation traditionally is used when a single residual focus is suspected. Our results, however, support the contention that multistage epilepsy surgery is safe, effective and useful in a challenging and select pediatric population with extratemporal medically refractory epilepsy.