PDF(Pubmed)
Abstract：
(1) Background: Hemispherotomy is the generally accepted treatment for hemispheric drug-resistant epilepsy (DRE). Lateral or vertical approaches are performed according to the surgeon\'s preference. Multiple technical variations have been proposed since Delalande first described his vertical technique. We propose a sub-insular variation of the vertical parasagittal hemispherotomy (VPH) and describe our case series of patients operated on using this procedure. (2) Methods: Data from a continuous series of patients with hemispheric DRE who were operated on by the senior author (CR) using the modified sub-insular VPH technique were analyzed retrospectively. Pre-operative demographic and epilepsy characteristics, functional outcome, and surgical complications were extracted from medical charts. (3) Results: Twenty-five patients were operated on between August 2008 and August 2023; 23 have at least 3 months of follow-up. Of this group, 20 (86.9%) patients are seizure-free. Only two patients developed postoperative hydrocephalus (8.7%). All patients who were able to walk autonomously preoperatively and 20 (86.9%) of those with follow-up were able to walk without assistance. A total of 17 (74%) patients were able to perform adapted social activities at the latest follow-up. (4) Conclusions: Modified sub-insular VPH is a successful surgical technique for hemispheric DRE with seizure freedom rates similar to the largest series reported in the literature. Compared to other series, patients who were operated on with our modified technique had a lower rate of postoperative hydrocephalus and excellent long-term motor and cognitive outcomes.
摘要：
(1)研究背景:半球体切开术是目前公认的治疗半球耐药癫痫(DRE)的方法。根据外科医生的偏好进行横向或垂直入路。自从Delalande首次描述他的垂直技术以来，已经提出了多种技术变体。我们提出了垂直矢状面旁半球切开术（VPH）的岛下变化，并描述了使用此程序进行手术的患者病例系列。（2）方法：回顾性分析了由高级作者（CR）使用改良岛下VPH技术进行手术的连续一系列半球DRE患者的数据。术前人口统计学和癫痫特征，功能结果，从医疗图表中提取手术并发症。（3）结果：在2008年8月至2023年8月期间，25例患者接受了手术；23例有至少3个月的随访。在这个群体中，20例（86.9%）患者无癫痫发作。只有两名患者发生术后脑积水（8.7％）。所有能够在术前自主行走的患者和20名（86.9％）的随访患者能够在没有帮助的情况下行走。在最新的随访中，共有17名（74％）患者能够进行适应性社交活动。（4）结论：改良岛下VPH是一种成功的治疗半球DRE的手术技术，其癫痫发作自由率与文献报道的最大系列相似。与其他系列相比，采用我们改良技术进行手术的患者术后脑积水发生率较低,长期运动和认知结局优异.
