Lee Jun Ho, Hwang Yong Soon, Shin Jun Jae, Kim Tae Hong, Shin Hyung Shik, Park Sang Keun
Department of Neurosurgery, Sanggye Paik Hospital, Inje University, College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2008 Oct;44(4):234-9. doi: 10.3340/jkns.2008.44.4.234. Epub 2008 Oct 30.
There are a few reports on the complications of surgery for epilepsy. We surveyed our data to present complications of epilepsy surgeries from the neurosurgeon's point of view and compare our results with other previous reports.
A total of 179 surgical procedures for intractable epilepsy (41 diagnostic, 138 therapeutic) were performed in 92 consecutive patients (10 adults, 82 children) during the last 9.2 years (February. 1997-April. 2006). Their medical records and radiological findings were reviewed to identify and analyze the surgical complications.
The diagnostic procedures encompassed various combinations of subdural grid, subdural strips, and depth electrodes. Four minor transient complications developed in 41 diagnostic procedures (4/41=9.8%). A total of 138 therapeutic procedures included 28 anterior temporal lobectomies, 21 other lobectomies, 6 lesionectomies, 21 topectomies, 13 callosotomies, 20 vagus nerve stimulations, 13 multiple subpial transections, and 16 hemispherectomies. Twenty-six complications developed in therapeutic procedures (26/138=18.8%). Out of the 26 complications, 21 complications were transient and reversible (minor; 21/138=15.2%), and 5 were serious complications (major; 5/138=3.6%). Five major complications were one visual field defect, two mortality cases and two vegetative states. There were 2 additional mortality cases which were not related to the surgery itself.
Our results indicate that complication rate was higher than previous other reports in minor complications and was comparable in major complications. However, our results show relatively high frequency of mortality cases and severe morbidity case compared to other previous reports. The authors would like to emphasize the importance of acute postoperative care in young pediatric patients as well as meticulous surgical techniques to reduce morbidity and mortality in epilepsy surgery.
关于癫痫手术并发症的报道较少。我们梳理了自身数据，从神经外科医生的角度呈现癫痫手术的并发症，并将我们的结果与之前的其他报道进行比较。
在过去的9.2年（1997年2月至2006年4月）期间，对92例连续患者（10例成人，82例儿童）进行了179例难治性癫痫手术（41例诊断性手术，138例治疗性手术）。回顾他们的病历和影像学检查结果，以识别和分析手术并发症。
诊断性手术包括硬膜下网格、硬膜下条带和深部电极的各种组合。41例诊断性手术中有4例出现轻微短暂并发症（4/41 = 9.8%）。138例治疗性手术包括28例前颞叶切除术、21例其他叶切除术、6例病灶切除术、21例皮质切除术、13例胼胝体切开术、20例迷走神经刺激术、13例多处软膜下横切术和16例大脑半球切除术。治疗性手术中有26例出现并发症（26/138 = 18.8%）。在这26例并发症中，21例为短暂且可逆的（轻微；21/138 = 15.2%），5例为严重并发症（严重；5/138 = 3.6%）。5例严重并发症包括1例视野缺损、2例死亡病例和2例植物状态。另外有2例死亡病例与手术本身无关。
我们的结果表明，轻微并发症的发生率高于之前的其他报道，严重并发症的发生率与之相当。然而，与之前的其他报道相比，我们的结果显示死亡病例和严重发病病例的频率相对较高。作者强调了小儿患者术后急性护理的重要性以及精细手术技术对于降低癫痫手术发病率和死亡率的重要性。
