Children's Hospital Boston, Boston, MA 02115, USA.
Semin Pediatr Neurol. 2010 Sep;17(3):182-9. doi: 10.1016/j.spen.2010.06.011.
Surgical treatment emerges as a therapeutic option for refractory status epilepticus (RSE) in children. Surgical approaches for RSE include focal cortical resections, hemispherectomies, multiple subpial transections, and rarely corpus callosotomy and vagal nerve stimulator implantation. Resective surgery has shown immediate- and long-term benefits in cases of definite localization of the epileptogenic focus by elecrographic and imaging data. Evidence of focal electrographic activity may not always be available during prolonged status. Nevertheless, resection may be an option in these cases if extensive, and confined pathology is seen on magnetic resonance imaging. On the contrary, electrographic localization may be complemented by intraoperative electrocorticography during multiple subpial transections in cases of nonlesional pathology. The optimal timing of surgery in eligible patients has been determined by concerns about medical intractability weighed against accumulating risks of RSE and the possible appearance of secondary epileptogenic zones caused by ongoing seizures. Overall, preliminary case series suggest that epilepsy surgery may be an alternative treatment option for selected children with RSE. Additional studies are needed to delineate timing and criteria for intervention as well as prognostic factors.
手术治疗成为儿童难治性癫痫持续状态（RSE）的一种治疗选择。RSE 的手术方法包括局灶性皮质切除术、半脑切除术、多发性软膜下横切术，很少采用胼胝体切开术和迷走神经刺激器植入术。对于通过电生理和影像学数据明确癫痫灶定位的病例，切除术显示出即刻和长期的益处。在长时间的癫痫持续状态中，不一定能获得局灶性电活动的证据。然而，如果磁共振成像显示广泛且局限的病变，那么切除术可能是一种选择。相反，如果在非病变性病变的情况下，电生理定位可以通过多次软膜下横切术中的术中皮层电图来补充。在考虑到 RSE 的累积风险和持续发作可能导致继发性致痫区的情况下，对有适应证的患者进行手术的最佳时机取决于对药物难治性的担忧。总的来说，初步的病例系列研究表明，癫痫手术可能是 RSE 儿童的一种替代治疗选择。需要进一步的研究来确定干预的时机和标准以及预后因素。
