Ansari Shaheryar F, Maher Cormac O, Tubbs R Shane, Terry Colin L, Cohen-Gadol Aaron A
Clarian Neuroscience Institute, Indianapolis Neurosurgical Group (ING), Indianapolis, IN, USA.
Childs Nerv Syst. 2010 Jul;26(7):945-51. doi: 10.1007/s00381-009-1056-7. Epub 2009 Dec 15.
Previous small studies have demonstrated that seizure outcomes following surgery for extratemporal lobe epilepsy (ETLE) in children are worse than those for temporal lobe epilepsy. We have conducted a meta-analysis of the available literature to better understand ETLE surgical outcomes in children.
We searched PubMed (1990-2009) for appropriate studies using the following terms: ETLE, ETLE surgery, ETLE surgery outcome, frontal lobe epilepsy, occipital lobe epilepsy, and parietal lobe epilepsy. Our collected data included patient age at seizure onset and surgery, the cerebral lobe involved with epileptogenesis, MRI findings, predominant seizure semiology, intracranial monitoring use (electrode implantation), epileptic region histopathology, and postoperative seizure outcome. Statistical analysis was performed to determine associations among these variables and postoperative outcome.
Ninety-five patients from 17 studies satisfied the inclusion criteria. Pathological findings (p = 0.039) and seizure type (p = 0.025) were significantly associated with outcome: A larger proportion of patients with cortical dysplasia and complex partial seizures experienced better outcomes. Age at surgery (p = 0.073) and the cerebral resection site (p = 0.059) were marginally associated with seizure outcome.
This study confirms previous reports: Surgical outcomes for ETLE epilepsy are significantly worse than those for temporal lobe epilepsy. The reasons for this difference may include the diffuse nature of the pathology involved in ETLE, difficulty in localizing the seizure focus in young children, and involvement of "eloquent" nonresectable cortex in epileptogenesis. Because of the reporting variability among different epilepsy centers, more uniform protocols are necessary for fair evaluation and comparison of outcomes among the different centers.
以往的小型研究表明，儿童颞叶外癫痫（ETLE）手术后的癫痫发作结果比颞叶癫痫更差。我们对现有文献进行了荟萃分析，以更好地了解儿童ETLE手术的结果。
我们在PubMed（1990 - 2009年）中使用以下术语搜索合适的研究：ETLE、ETLE手术、ETLE手术结果、额叶癫痫、枕叶癫痫和顶叶癫痫。我们收集的数据包括癫痫发作起始和手术时的患者年龄、涉及癫痫发生的脑叶、MRI结果、主要癫痫发作症状学、颅内监测使用情况（电极植入）、癫痫区域组织病理学以及术后癫痫发作结果。进行统计分析以确定这些变量与术后结果之间的关联。
来自17项研究的95名患者符合纳入标准。病理结果（p = 0.039）和癫痫发作类型（p = 0.025）与结果显著相关：皮质发育异常和复杂部分性发作的患者中，有更大比例的患者预后较好。手术年龄（p = 0.073）和脑切除部位（p = 0.059）与癫痫发作结果有边缘关联。
本研究证实了先前的报告：ETLE癫痫的手术结果明显比颞叶癫痫更差。这种差异的原因可能包括ETLE所涉及病理的弥漫性、幼儿癫痫病灶定位困难以及“明确的”不可切除皮质参与癫痫发生。由于不同癫痫中心之间报告的差异，需要更统一的方案来公平评估和比较不同中心的结果。
