背景:体call切开术(CC)适用于双侧或弥漫性癫痫发作的患者,或单侧发作并迅速扩散到对侧大脑半球的癫痫发作。耐药癫痫患者CC的效率是一个长期关注的问题,因为大多数报道CC手术结果的文章都来自小病例系列,随访的持续时间各不相同。
方法:PubMed,Embase,科克伦图书馆,和WebofScience进行了搜索,以确定2021年11月8日之前发表的论文。系统审查是按照PRISMA指南完成的。结果通过比例的荟萃分析进行分析。
结果:共有1644例耐药癫痫患者(49例回顾性或前瞻性病例系列研究)接受了CC,所有患者的随访时间至少为1年。完全发作自由率(SF)为12.38%(95%置信区间[CI],8.17%-17.21%)。同时,来自下降攻击的完全SF率为61.86%(95%CI,51.87%-71.41%)。全骨体切开术(TCC)和前骨体切开术(ACC)后完全SF的发生率分别为11.41%(95%CI,5.33%-18.91%)和6.75%(95%CI,2.76%-11.85%),分别。此外,TCC后掉落攻击的完全SF率明显高于ACC后(71.52%,95%CI,54.22%-86.35%与57.11%,95%CI,42.17%-71.49%)。通过GRADE评估,三个结果的证据质量为低至中等。
结论:TCC和ACC之间的完全SF率没有显着差异。TCC从掉落攻击中获得的完整SF的比率明显高于ACC。此外,用于治疗耐药癫痫的CC仍然是进一步研究的重要问题,因为对于CC的程度及其对患者的益处,尚无普遍接受的标准化指南。在未来的研究中,我们将关注这个问题。
Corpus callosotomy (CC) is appropriate for patients with seizures of a bilateral or diffuse origin, or those with seizures of a unilateral origin with rapid spread to the contralateral cerebral hemisphere. The efficiency of CC in patients with drug-resistant epilepsy is a long-term concern because most articles reporting the surgical results of CC arise from small case series, and the durations of follow-up vary.
PubMed, Embase, Cochrane Library, and Web of Science were searched to identify papers published before November 8, 2021. The systematic review was completed following PRISMA guidelines. Outcomes were analyzed by meta-analysis of the proportions.
A total of 1644 patients with drug-resistant epilepsy (49 retrospective or prospective case series studies) underwent CC, and the follow-up time of all patients was at least 1 year. The rate of complete seizure freedom (SF) was 12.38% (95% confidence interval [CI], 8.17%-17.21%). Meanwhile, the rate of complete SF from drop attacks was 61.86% (95% CI, 51.87%-71.41%). The rates of complete SF after total corpus callosotomy (TCC) and anterior corpus callosotomy (ACC) were 11.41% (95% CI, 5.33%-18.91%) and 6.75% (95% CI, 2.76%-11.85%), respectively. Additionally, the rate of complete SF from drop attacks after TCC was significantly higher than that after ACC (71.52%, 95% CI, 54.22%-86.35% vs. 57.11%, 95% CI, 42.17%-71.49%). The quality of evidence for the three outcomes by GRADE assessment was low to moderate.
There was no significant difference in the rate of complete SF between TCC and ACC. TCC had a significantly higher rate of complete SF from drop attacks than did ACC. Furthermore, CC for the treatment of drug-resistant epilepsy remains an important problem for further investigation because there are no universally accepted standardized guidelines for the extent of CC and its benefit to patients. In future research, we will focus on this issue.