Sinclair D Barry, Aronyk Keith, Snyder Thomas, McKean John D S, Wheatley Matt, Gross Donald, Bastos Alexander, Ahmed S Nizamuddin, Hao Chunghai, Colmers William
Comprehensive Epilepsy Program, University Of Alberta, Edmonton, Alberta, Canada.
Pediatr Neurol. 2004 Mar;30(3):177-85. doi: 10.1016/j.pediatrneurol.2003.07.005.
There have been relatively few studies reporting the safety, efficacy, and outcome in children undergoing extratemporal resection for epilepsy. We reviewed the pediatric cases of extratemporal resection for intractable epilepsy performed by the Comprehensive Epilepsy Program at the University of Alberta Hospitals between 1988-1998. Thirty-five patients were studied, 14 male and 21 female. The age at operation ranged from 6 months to 16 years. The operations included frontal excisions (12), parietal (8), occipital (4), hemispherectomies or multilobar resections (10), and one removal of a hypothalamic hamartoma. The pathology at surgery included patients with focal cortical dysplasia (8), brain tumors (6), neurocutaneous syndrome (7), Rasmussen's encephalitis (2), porencephalic cysts (4), hypothalamic hamartoma (1), and nonspecific gliosis (6). Twenty-four of 35 patients (68.5%) had an Engel Class I outcome after surgery and an additional six patients (11%) had a significant decrease in seizure frequency (Engel Class III). Complications were observed in two patients (5%) and there were no deaths. Extratemporal resection is a safe and effective treatment for children with intractable epilepsy. Overall, 68% of patients were seizure-free after surgery, although outcome may be dependent on site and pathology. A wide range of developmental pathology was observed including focal cortical dysplasia, brain tumors, and lesions with neurocutaneous syndromes. Many families reported improvement in behavior and psychosocial function after surgery.
关于接受颞外切除术治疗癫痫的儿童的安全性、疗效及预后的研究相对较少。我们回顾了1988年至1998年间阿尔伯塔大学医院综合癫痫项目开展的颞外切除术治疗难治性癫痫的儿科病例。共研究了35例患者，其中男性14例，女性21例。手术年龄范围为6个月至16岁。手术包括额叶切除术（12例）、顶叶切除术（8例）、枕叶切除术（4例）、大脑半球切除术或多叶切除术（10例），以及1例下丘脑错构瘤切除术。手术病理包括局灶性皮质发育不良患者（8例）、脑肿瘤（6例）、神经皮肤综合征（7例）、拉斯姆森脑炎（2例）、脑穿通畸形囊肿（4例）、下丘脑错构瘤（1例）和非特异性胶质增生（6例）。35例患者中有24例（68.5%）术后达到恩格尔I级预后，另有6例患者（11%）癫痫发作频率显著降低（恩格尔III级）。2例患者（5%）出现并发症，无死亡病例。颞外切除术是治疗儿童难治性癫痫的一种安全有效的方法。总体而言，68%的患者术后无癫痫发作，尽管预后可能取决于手术部位和病理情况。观察到多种发育性病理情况，包括局灶性皮质发育不良、脑肿瘤和伴有神经皮肤综合征的病变。许多家庭报告术后患儿行为及社会心理功能有所改善。
