Leiphart J W, Peacock W J, Mathern G W
Division of Neurosurgery, Mental Retardation Research Center and Brain Research Institute, University of California, Los Angeles, CA, USA.
Pediatr Neurosurg. 2001 Jun;34(6):311-8. doi: 10.1159/000056044.
Pediatric epilepsy surgery patients are different than adult epilepsy surgery patients by having a higher proportion of extratemporal than temporal lobe lesions, and by having cortical dysplasia as the most frequent pathology. We analyzed 111 pediatric epilepsy patients who received lobar or multilobar resections at the University of California, Los Angeles, between the years 1986 and 2000 to determine if there were differences in seizure outcome by lobe of resection and tissue pathology. Results showed that temporal lobe resection patients had lower pre- and postoperative seizure frequencies compared with extratemporal single lobe resection patients (p < 0.05). Furthermore, single lobe resection patients from any brain region had lower pre- and postoperative seizure frequencies compared with multilobar resection patients (p < 0.05), an effect which was due to the better seizure outcomes in temporal lobe resection cases. Patients with mass lesions had the best postoperative seizure control, followed by cortical dysplasia patients and other pathologies (p < 0.05). In all patient groups, there was a significant reduction in pre- to postoperative seizure frequencies (p < 0.0001). These results indicate that postsurgery seizure outcomes in pediatric epilepsy surgery patients vary by lesion location and pathology, with the best outcomes in temporal lobe patients with mass lesions. However, surgical resections of epileptogenic lesions, regardless of lobe, were associated with significant postoperative improvements in seizure frequency.
小儿癫痫手术患者与成人癫痫手术患者不同，颞叶外病变的比例高于颞叶病变，且皮质发育异常是最常见的病理类型。我们分析了1986年至2000年间在加利福尼亚大学洛杉矶分校接受叶或多叶切除术的111例小儿癫痫患者，以确定切除叶和组织病理学在癫痫发作结果方面是否存在差异。结果显示，与颞叶外单叶切除患者相比，颞叶切除患者术前和术后的癫痫发作频率较低（p<0.05）。此外，与多叶切除患者相比，任何脑区的单叶切除患者术前和术后的癫痫发作频率较低（p<0.05），这一效应是由于颞叶切除病例的癫痫发作结果较好。有占位性病变的患者术后癫痫控制最佳，其次是皮质发育异常患者和其他病理类型患者（p<0.05）。在所有患者组中，术前至术后的癫痫发作频率均显著降低（p<0.0001）。这些结果表明，小儿癫痫手术患者的术后癫痫发作结果因病变位置和病理类型而异，颞叶有占位性病变的患者结果最佳。然而，癫痫病灶的手术切除，无论在哪个脑叶，都与术后癫痫发作频率的显著改善相关。
