INTRACTABLE EPILEPSY AND STRUCTURAL LESIONS OF THE BRAIN - MAPPING, RESECTION STRATEGIES, AND SEIZURE OUTCOME
INTRACTABLE EPILEPSY AND STRUCTURAL LESIONS OF THE BRAIN - MAPPING, RESECTION STRATEGIES, AND SEIZURE OUTCOME
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DOI：
10.1111/j.1528-1157.1991.tb05242.x
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发表时间：
1991-03-01
期刊：
影响因子：
5.6
通讯作者：
LUDERS, H
中科院分区：
文献类型：
--
作者：
AWAD, IA;ROSENFELD, J;LUDERS, H
研究人员对 47 名神经影像学检查中患有结构性脑损伤和药物治疗难治性部分性癫痫的患者进行了研究。 进行了长时间的无创发作间期和发作期脑电图记录，然后使用长期植入的硬膜下电极板进行更集中的绘图。 手术程序包括病灶活检、最大病灶切除和/或癫痫发生区的切除，具体取决于言语或其他功能区域的可及性和参与情况。 11 名患者的致痫区仅涉及结构性病变附近的区域。 18 名患者的病变超出了病变范围。 其他 18 名患者的癫痫发生区域较远且不连续。 无论癫痫病灶切除范围如何，18 例患者中的 17 例 (94%) 术后均实现了癫痫控制，病灶完全切除。 6 名病灶不完全切除但癫痫病灶完全切除的患者中有 5 名 (83%) 术后控制了癫痫，23 名病灶不完全切除和病灶不完全切除的患者中有 12 名 (52%) 术后癫痫得到控制。 病灶切除的程度与手术结果本身（p < 0.003）或与病灶切除结合的结果密切相关。 作为二分变量，病灶切除与手术结果有轻微相关性（p = 0.048），并且仅作为三级结果变量显示出显着性趋势（p = 0.07）。 我们得出的结论是，结构性病变与大脑邻近和偏远区域的癫痫发生区域有关。 最大限度地切除病灶是控制顽固性癫痫的最佳机会；然而，许多患者通过仔细计划的病灶或病灶次全切除术来控制癫痫发作。 讨论了病灶和病灶的标测和切除策略，包括可能需要或不需要侵入性记录的情况。
Forty-seven patients with structural brain lesions on neuroimaging studies and partial epilepsy intractable to medical therapy were studied. Prolonged noninvasive interictal and ictal EEG recording was performed, followed by more focused mapping using chronically implanted subdural electrode plates. Surgical procedures included lesion biopsy, maximal lesion excision, and/or resection of zones of epileptogenesis depending on accessibility and involvement of speech or other functional areas. The epileptogenic zone involved exclusively the region adjacent to the structural lesion in 11 patients. It extended beyond the lesion in 18 patients. Eighteen other patients had remote noncontiguous zones of epileptogenesis. Postoperative control of epilepsy was accomplished in 17 of 18 patients (94%) with complete lesion excision regardless of extent of seizure focus excision. Postoperative control of epilepsy was accomplished in 5 of 6 patients (83%) with incomplete lesion excision but complete seizure focus excision and in 12 of 23 patients (52%) with incomplete lesion excision and incomplete focus excision. The extent of lesion resection was strongly associated with surgical outcome either in itself (p < 0.003), or in combination with focus excision. Focus resection was marginally associated with surgical outcome as a dichotomous variable (p = 0.048) and showed a trend toward significance (p = 0.07) only as a three-level outcome variable. We conclude that structural lesions are associated with zones of epileptogenesis in neighboring and remote areas of the brain. Maximum resection of the lesion offers the best chance at controlling intractable epilepsy; however, seizure control is achieved in many patients by carefully planned subtotal resection of lesions or foci. Strategies for mapping and for resection of lesions and foci are discussed, including cases in which invasive recordings may or may not be necessary.