Hong S C, Kang K S, Seo D W, Hong S B, Lee M, Nam D H, Lee J I, Kim J S, Shin H J, Park K, Eoh W, Suh Y L, Kim J H
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Neurosurg. 2000 Nov;93(5):766-73. doi: 10.3171/jns.2000.93.5.0766.
Surgical treatment of cortical dysplasia (CD) together with intractable seizures is challenging because both visualization and localization of the lesion are difficult, correlation with seizure foci requires comprehensive study, and the surgical outcomes reported thus far are unsatisfactory. The authors report their experience in the surgical treatment of CD classified according to a surgical point of view.
The definition of CD used in this study was a dysplastic lesion visible on magnetic resonance (MR) images or a lesion that, although not visible on MR images, was diagnosed as moderate-to-severe dysplasia by using pathological analysis. During the last 4.5 years, the authors treated 36 patients with intractable epilepsy accompanied by CD. They divided the 36 cases of CD into four characteristic groups: Group A, diffuse bilateral hemispheric dysplasia; Group B, diffuse lobar dysplasia; Group C, focal dysplasia; and Group D, a moderate to severe degree of CD with a normal appearance on MR images. All but one patient in Group C were monitored in the epilepsy monitoring unit by using subdural electrodes for seizure localization and functional mapping. The incidence of CD among a cohort of 291 patients who had undergone epilepsy surgery at the authors' center during the study period was 12.4%. The mean age of the 36 patients was 21.3 years and the mean age at seizure onset was 8.5 years. The mean follow-up period was 26 months. Twenty-six patients (72.2%) belonged to Engel Class I or II (20 and six, respectively). There were five cases in Group A, nine in Group B, nine in Group C, and 13 in Group D. Patients in Groups A and B were significantly younger at seizure onset and had significantly poorer surgical outcomes compared with patients in Groups C and D (p < 0.05). If outcome is compared on the basis of the extent of removal of CD, patients in whom CD was completely removed had significantly better outcomes than those in whom CD was only partially removed (p < 0.001).
The authors conclude that intractable epilepsy accompanied by CD can be treated surgically using comprehensive preoperative approaches. Deliberate resective procedures aimed at complete removal of dysplastic tissue ensure excellent seizure control without permanent neurological deficit.
皮质发育异常（CD）合并难治性癫痫的手术治疗具有挑战性，因为病变的可视化和定位都很困难，与癫痫病灶的相关性需要全面研究，而且迄今为止报道的手术效果并不理想。作者报告了他们根据手术观点对CD进行手术治疗的经验。
本研究中使用的CD定义为在磁共振（MR）图像上可见的发育异常病变，或虽在MR图像上不可见，但经病理分析诊断为中重度发育异常的病变。在过去4.5年中，作者治疗了36例伴有CD的难治性癫痫患者。他们将36例CD病例分为四个特征组：A组，弥漫性双侧半球发育异常；B组，弥漫性叶发育异常；C组，局灶性发育异常；D组，MR图像外观正常的中重度CD。除C组一名患者外，其余患者均在癫痫监测单元使用硬膜下电极进行癫痫定位和功能图谱监测。在研究期间，作者中心接受癫痫手术的291例患者中CD的发生率为12.4%。36例患者的平均年龄为21.3岁，癫痫发作的平均起始年龄为8.5岁。平均随访期为26个月。26例患者（72.2%）属于恩格尔I级或II级（分别为20例和6例）。A组5例，B组9例，C组9例，D组13例。与C组和D组患者相比，A组和B组患者癫痫发作的起始年龄明显更小，手术效果明显更差（p<0.05）。如果根据CD切除范围比较结果，CD被完全切除的患者的效果明显优于CD仅被部分切除的患者（p<0.001）。
作者得出结论，伴有CD的难治性癫痫可以通过全面的术前方法进行手术治疗。旨在完全切除发育异常组织的刻意切除手术可确保良好的癫痫控制，且无永久性神经功能缺损。
