目的:虽然大脑半球切除术是治疗儿童难治性癫痫综合征的有效方法,多达40%的患者最终出现癫痫发作复发.这些患者癫痫发作复发的原因尚不完全清楚。作者试图在他们的中心评估大脑半球切除术的疗效,并确定对侧MRI异常是否可以预测癫痫发作复发。
方法:对2000年1月至2014年6月在迈阿密儿童医院进行的连续半球切除术进行了回顾性回顾。进行时间至事件分析。“事件”定义为切除性癫痫手术后的任何癫痫发作(不包括术后第一周的癫痫发作和光环)。分析了几个术前变量,以确定它们是否适合预测手术后的癫痫复发。
结果:69名患者(44名男孩),平均年龄为8.2±5.9岁(范围0.1-20.8岁),接受了72例半球切除术;其中67例为功能性半球切除术,而另外5人完成了先前的功能性半球切除术(2次完成了功能性半球切除术,3解剖半球切除术)。癫痫的持续时间为5.8±5.5年,其中66例(91.7%)每天发作。病因包括中风(n=28),皮质发育畸形(n=11),半脑畸形(n=11),脑炎(n=13),和其他(n=7)。在1年和2年的随访中,有59例(86%)和56例(81%)患者获得了EngelI类结果,分别。平均癫痫发作复发时间为33.5±31.1个月。在单变量分析中,在MRI上没有对侧异常(HR4.09,95%CI1.41-11.89,p=0.009)与癫痫发作持续时间较长有关.对侧MRI异常的存在与术前头皮脑电图对侧发作性癫痫发作有关(p=0.002)。15例患者出现20例并发症(20/72,27.8%),包括9例(13%)脑积水的发展,需要分流脑脊液,1例潮水瘤,1例半球水肿,2例无菌性脑膜炎,2例术后出血,2例感染,2例缺血性脑卒中,1例输血感染丙型肝炎。
结论:双半球异常患者,对侧MRI异常证明,功能性大脑半球切除术后早期癫痫复发的风险较高。
背景:EVD=心室外引流;MCD=皮质发育畸形;MEG=脑磁图;PVWM=脑室周围白质;TTE=事件发生时间;VPS=脑室-腹腔分流术。
OBJECTIVE: Although hemispherectomy is an effective treatment for children with intractable hemispheric epilepsy syndromes, as many as 40% of patients eventually develop seizure recurrence. The causes of seizure recurrence in these patients are incompletely understood. The authors sought to evaluate the efficacy of hemispherectomy at their center and determine whether contralateral MRI abnormalities can predict seizure recurrence.
METHODS: A retrospective review of consecutive hemispherectomies performed at Miami Children\'s Hospital between January 2000 and June 2014 was performed. Time-to-event analysis was performed. The \"event\" was defined as any seizures following resective epilepsy surgery (not including seizures in the first postoperative week and auras). Several preoperative variables were analyzed to determine their suitability to predict seizure recurrence following surgery.
RESULTS: Sixty-nine patients (44 boys) with a mean age of 8.2 ± 5.9 years (range 0.1-20.8 years) underwent 72 hemispherectomies; 67 of these were functional hemispherectomies, while another 5 were completion of a previous functional hemispherectomy (2 completions of functional hemispherectomies, 3 anatomical hemispherectomies). The duration of epilepsy was 5.8 ± 5.5 years with 66 cases (91.7%) having daily seizures. Etiology included stroke (n = 28), malformation of cortical development (n = 11), hemimegalencephaly (n = 11), encephalitis (n = 13), and other (n = 7). Engel class I outcome was achieved in 59 (86%) and 56 (81%) patients at 1 and 2 years of follow-up, respectively. The mean time to seizure recurrence was 33.5 ± 31.1 months. In univariate analyses, the absence of contralateral abnormalities on MRI (HR 4.09, 95% CI 1.41-11.89, p = 0.009) was associated with a longer duration of seizure freedom. The presence of contralateral MRI abnormalities was associated with contralateral ictal seizures on preoperative scalp EEG (p = 0.002). Fifteen patients experienced 20 complications (20/72, 27.8%), including the development of hydrocephalus necessitating CSF diversion in 9 cases (13%), hygroma in 1, hemispheric edema in 1, aseptic meningitis in 2, postoperative hemorrhage in 2, infection in 2, ischemic stroke in 2, and blood transfusion-contracted hepatitis C in 1 case.
CONCLUSIONS: Patients with bihemispheric abnormalities, as evidenced by contralateral MRI abnormalities, have a higher risk of earlier seizure recurrence following functional hemispherectomy.
BACKGROUND: EVD = external ventricular drain; MCD = malformation of cortical development; MEG = magnetoencephalography; PVWM = periventricular white matter; TTE = time-to-event; VPS = ventriculoperitoneal shunt.