Salanova V, Markand O, Worth R
Department of Neurology, Indiana University Medical Center, University Hospital, Indianapolis, Indiana 46202, USA.
Epilepsia. 2002 Feb;43(2):170-4. doi: 10.1046/j.1528-1157.2002.33800.x.
We studied the surgical outcome, complications, and the late mortality rate in a large group of patients with medically refractory temporal lobe epilepsy (TLE).
Two-hundred fifteen patients with TLE were treated surgically between 1984 and 1999 after a comprehensive presurgical evaluation. Patients were followed up at 6 weeks, 3-6 months, and yearly thereafter. In addition, questionnaires were sent on the anniversary of their surgery. Surgical outcome (Engel's classification), complication rate, and factors contributing to late mortality were analyzed. Standardized mortality ratios (SMRs) were calculated.
There was no surgical mortality. Two (0.9%) had mild hemiparesis, one (0.4%) had a hemianopia, seven (3.2%) had transient cranial nerve palsies, and eight (3.7%) had transient postoperative language difficulties. One hundred forty-eight (69%) became seizure free, 43 (20%) had rare seizures, 14 (6.5%) had worthwhile seizure reduction, and 10 (4.6%) had no improvement (follow-up, 1-15 years). Three (2%) of 148 seizure-free patients died during follow-up, compared with eight (11.9%) of 67 not seizure-free patients. The mean duration of epilepsy before surgery for the surviving patients was 17.8 years, and for those patients who died, 25.9 years (p < 0.05). Six (5.7%) of 104 patients with right-sided resections died during follow-up, compared with five (4.5%) of 111 with left-sided resections.
Eighty-nine percent of patients became seizure free or had rare seizures, with low morbidity, and no surgical mortality. The late mortality occurred predominantly in patients with persistent seizures (SMR, 7.4). Those patients who died had a longer duration of epilepsy before surgery. In contrast, among those patients who became seizure free, the mortality rate was much lower, and similar to the general population of Indiana (SMR, 1.7).
我们研究了一大群药物难治性颞叶癫痫（TLE）患者的手术疗效、并发症及晚期死亡率。
1984年至1999年间，对215例TLE患者进行了全面的术前评估后进行手术治疗。术后6周、3至6个月进行随访，此后每年随访一次。此外，在患者手术周年时发放问卷。分析手术疗效（恩格尔分类）、并发症发生率及导致晚期死亡的因素。计算标准化死亡率（SMR）。
无手术死亡病例。2例（0.9%）出现轻度偏瘫，1例（0.4%）出现偏盲，7例（3.2%）出现短暂性颅神经麻痹，8例（3.7%）出现术后短暂性语言困难。148例（69%）患者术后无癫痫发作，43例（20%）有罕见癫痫发作，14例（6.5%）癫痫发作有明显减少，10例（4.6%）无改善（随访1至15年）。148例无癫痫发作患者中有3例（2%）在随访期间死亡，而67例非无癫痫发作患者中有8例（11.9%）死亡。存活患者术前癫痫的平均病程为17.8年，死亡患者为25.9年（p<0.05）。104例行右侧切除术的患者中有6例（5.7%）在随访期间死亡，111例行左侧切除术的患者中有5例（4.5%）死亡。
89%的患者术后无癫痫发作或有罕见癫痫发作，发病率低，无手术死亡。晚期死亡主要发生在持续性癫痫发作的患者中（SMR，7.4）。死亡患者术前癫痫病程较长。相比之下，无癫痫发作患者的死亡率要低得多，与印第安纳州普通人群相似（SMR，1.7）。
