难治性癫痫切除术后再手术的长期疗效观察

doi:10.19854/j.cnki.1008-2425.2023.04.0004

摘要/Abstract

摘要： 目的探讨难治性癫痫患者切除术后再次手术治疗的长期手术疗效和安全性。方法回顾性纳入我中心2011年1月至2018年12月收治的再次行切除/离断手术治疗的癫痫患者,采用Engel分级标准评估术后疗效并随访手术相关并发症。结果共纳入32例患者,手术方式包括大脑半球离断术2例、多脑叶切除/离断术9例和单脑叶癫痫灶扩大切除术21例。围手术期手术相关并发症包括:5例皮下积液(其中1例合并切口感染);3例短暂运动功能障碍或失语;1例硬膜下积液;1例颅内感染;1例颅内出血合并脑积水和右下肢运动功能障碍。末次随访有2例失随访,其余30例平均随访79.4±25.1个月(36~121个月),术后疗效按Engel分级为:EngelⅠ级13例(43.3%);EngelⅡ级7例(23.3%);Engel Ⅲ级3例(10.0%);Engel Ⅳ级7例(23.3%)。随访期内无新发手术相关并发症。结论难治性癫痫切除性手术失败后,再次进行综合评估并手术,其总体的长期手术疗效和安全性较好。

关键词: 难治性癫痫, 切除手术, 再手术, 疗效

Abstract: Objective To investigate the long-term surgical outcome and safety of reoperation following resective surgeryin patients with refractory epilepsy.Methods Epilepsy patients who were admitted to our center from January 2011 to December 2018 for reoperation were retrospectively included.The surgical outcome of the patients was evaluated using Engel class and the surgery-related complications were observed and documented.Results A total of 32 patients were included,of whom2 hadhemispherotomy,9 had multiple lobe resection or disconnection and 21 had extended resection of epileptic foci restricted to a single lobe.Surgery-related perioperative complications included:subcutaneous effusion (one of which was combined with incisional infection)in 5,transient motor dysfunction or aphasiain 3,subdural effusion in one,intracranial infectionin one,and intracranial hemorrhage combined with hydrocephalus and right lower extremity motordysfunctionin one.2 cases were lost at the final follow-up,and the remaining 30 cases were followed up for a mean of 79.4±25.1 months (36-121 months).The postoperative outcomes including:13 (43.3%) were Engel I;7 (23.3%) wereEngel II;3 (10.0%) were Engel III;and 7 (23.3%) were Engel IV.There were no new surgery-related complications occurredduring the follow-up period.Conclusion The overall long-term surgical outcome and safety of reoperation for refractory epilepsy is good despite failure of the previous resective surgery.

Key words: Refractory epilepsy, Resective surgery, Reoperation, Surgical outcome

中图分类号:

R742.1

李焕发, 刘永, 孟强, 武昊, 董珊, 刘晓芳, 张华. 难治性癫痫切除术后再手术的长期疗效观察[J]. 立体定向和功能性神经外科杂志, 2023, 36(4): 213-216.

Li Huanfa, Liu Yong, Meng Qiang, et al. Long-term outcome of reoperation following resective surgery for refractory epilepsy[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(4): 213-216.

参考文献

[1] Liu JT,Liu B,Zhang H.Surgical versus medical treatment of drug-resistant epilepsy:A systematic review and meta-analysis[J].Epilepsy Behav,2018,82:179~188.
[2] Tellez-Zenteno JF,Hernandez RL,Moien-Afshari F,et al.Surgical outcomes in lesional and non-lesional epilepsy:a systematic review and meta-analysis[J].Epilepsy Res,2010,89(2-3):310~318.
[3] Najm I,Jehi L,Palmini A,et al.Temporal patterns and mechanisms of epilepsy surgery failure[J].Epilepsia,2013,54(5):772~782.
[4] Jehi L,Sarkis R,Bingaman W,et al.When is a postoperative seizure equivalent to “epilepsy recurrence” after epilepsy surgery?[J].Epilepsia,2010,51(6):994~1003.
[5] Bjellvi J,Flink R,Rydenhag B,et al.Complications of epilepsy surgery in Sweden 1996-2010:a prospective,population-based study[J].J Neurosurg,2015,122(3):519~525.
[6] Mcintosh AM,Kalnins RM,Mitchell LA,et al.Temporal lobectomy:long-term seizure outcome,late recurrence and risks for seizure recurrence[J].Brain,2004,127(Pt 9):2018~2030.
[7] Ryzi M,Brazdil M,Novak Z,et al.Long-term outcomes in patients after epilepsy surgery failure[J].Epilepsy Res,2015,110:71~77.
[8] Jehi LE,Silveira DC,Bingaman W,et al.Temporal lobe epilepsy surgery failures:predictors of seizure recurrence,yield of reevaluation,and outcome following reoperation[J].J Neurosurg,2010,113(6):1186~1194.
[9] Fukuda M,Masuda H,Shirozu H,et al.Additional resective surgery after the failure of initial surgery in patients with intractable epilepsy[J].Neurol Res,2017,39(12):1049~1055.
[10] Englot DJ,Han SJ,Rolston JD,et al.Epilepsy surgery failure in children:a quantitative and qualitative analysis[J].J Neurosurg Pediatr,2014,14(4):386~395.
[11] Jehi L,Yehia L,Peterson C,et al.Preliminary report:Late seizure recurrence years after epilepsy surgery may be associated with alterations in brain tissue transcriptome[J].Epilepsia Open,2018,3(2):299~304.
[12] Goellner E,Bianchin M M,Burneo J G,et al.Timing of early and late seizure recurrence after temporal lobe epilepsy surgery[J].Epilepsia,2013,54(11):1933~1941.
[13] Vaugier L,Lagarde S,Mcgonigal A,et al.The role of stereoelectroencephalography (SEEG) in reevaluation of epilepsy surgery failures[J].Epilepsy Behav,2018,81:86~93.[14] Hyslop A,Wang S,Bryant JP,et al.Stereo-electroencephalography (SEEG) in pediatric epilepsy:Utility in children with and without prior epilepsy surgery failure[J].Epilepsy Res,2021,177:106765.
[15] Shaver EG,Harvey AS,Morrison G,et al.Results and complications after reoperation for failed epilepsy surgery in children[J].Pediatr Neurosurg,1997,27(4):194~202.
[16] Krucoff MO,Chan AY,Harward SC,et al.Rates and predictors of success and failure in repeat epilepsy surgery:A meta-analysis and systematic review[J].Epilepsia,2017,58(12):2133~2142.
[17] Gonzalez-Martinez JA,Srikijvilaikul T,Nair D,et al.Long-term seizure outcome in reoperation after failure of epilepsy surgery[J].Neurosurgery,2007,60(5):873~880.
[18] Siegel AM,Cascino GD,Meyer FB,et al.Resective reoperation for failed epilepsy surgery:seizure outcome in 64 patients[J].Neurology,2004,63(12):2298~2302.
[19] Grote A,Witt JA,Surges R,et al.A second chance-reoperation in patients with failed surgery for intractable epilepsy:long-term outcome,neuropsychology and complications[J].J Neurol Neurosurg Psychiatry,2016,87(4):379~385.
[20] Schmeiser B,Zentner J,Steinhoff B J,et al.The role of presurgical EEG parameters and of reoperation for seizure outcome in temporal lobe epilepsy[J].Seizure,2017,51:174~179.
[21] Jung R,Aull-Watschinger S,Moser D,et al.Is reoperation an option for patients with temporal lobe epilepsy after failure of surgery?[J].Seizure,2013,22(7):502~506.
[22] Sacino MF,Ho CY,Whitehead MT,et al.Repeat surgery for focal cortical dysplasias in children:indications and outcomes[J].J Neurosurg Pediatr,2017,19(2):174~181.
[23] Bower RS,Wirrell EC,Eckel LJ,et al.Repeat resective surgery in complex pediatric refractory epilepsy:lessons learned[J].J Neurosurg Pediatr,2015,16(1):94~100.