目的:功能性大脑半球切除术是选择耐药癫痫患者的有效手术干预措施。在过去的几十年里,术前评估发生了戏剧性的变化,外科技术,和术后护理。这里,作者对1987年至2022年在病童医院接受大脑半球切除术的146名儿童的病历进行了回顾性回顾,提供了35年来手术和患者预后的独特概述。
方法:回顾了1987年至2022年在病童医院接受大脑半球切除术的所有儿童的病历。人口统计信息,术前临床特征,短期和长期癫痫发作结果,并记录有关术后并发症的详细信息.
结果:分析了146名儿童的癫痫发作结果。有68名女性和78名男性,平均年龄为5.08岁,其中123例在术后短期随访中表现出癫痫发作自由(EngelIA级),在长期随访中表现为89。半球切除术在实现长期控制癫痫发作方面的有效性随着时间的推移而提高(β=0.06,p<0.001)。与总体癫痫发作自由相关的因素包括大脑半球切除术时的年龄较小和作为癫痫发作病因的中风。以及在第一次手术中完全断开。此外,进行大脑半球切除术的癫痫的病因随着时间的推移而扩大,而并发症发生率保持不变。
结论:对于某些耐药癫痫病例,半子宫切除术是一种越来越有效的治疗方法。进行大脑半球切除术的癫痫的病因正在扩大,其安全性没有变化。当癫痫的病因是缺血性损伤时,癫痫发作结果更好,手术后最常见的并发症是脑积水。这些发现加强了大脑半球切除术作为某些耐药癫痫患者安全有效的治疗选择的持续使用。支持其应用于更广泛的病因,并强调未来的调查领域。
OBJECTIVE: Functional
hemispherectomy is an effective surgical intervention for select patients with drug-resistant epilepsy. The last several decades have seen dramatic evolutions in preoperative evaluation, surgical techniques, and postoperative care. Here, the authors present a retrospective review of the medical records of 146 children who underwent hemispherectomy between 1987 and 2022 at The Hospital for Sick Children, providing a unique overview of the evolution of the procedure and patient outcomes over 35 years.
METHODS: The medical records of all children who underwent
hemispherectomy at The Hospital for Sick Children between 1987 and 2022 were reviewed. Demographic information, preoperative clinical features, short-term and long-term seizure outcomes, and details regarding postoperative complications were recorded.
RESULTS: The seizure outcomes of 146 children were analyzed. There were 68 females and 78 males with a mean age of 5.08 years, 123 of whom demonstrated seizure freedom (Engel class IA) in the short-term postoperative follow-up period and 89 in the long term. The effectiveness of
hemispherectomy in achieving long-term seizure control has improved over time (β = 0.06, p < 0.001). Factors associated with overall seizure freedom included younger age at the time of
hemispherectomy and stroke as the etiology of seizures, as well as complete disconnection during the first surgery. Additionally, the etiologies of epilepsy for which hemispherectomy is performed have expanded over time, while complication rates have remained unchanged.
CONCLUSIONS: Hemispherectomy is an increasingly effective treatment for certain cases of drug-resistant epilepsy. The etiologies of epilepsy for which hemispherectomy is performed are broadening, with no change in its safety profile. Seizure outcomes are better when the etiology of epilepsy is an ischemic injury, and the most common complication after the procedure is hydrocephalus. These findings reinforce the ongoing use of
hemispherectomy as a safe and effective treatment option for certain individuals with drug-resistant epilepsy, support its application to a broader range of etiologies, and highlight areas of future investigation.