Hur Yun Jung, Kang Hoon-Chul, Kim Dong Seok, Choi Sae Rom, Kim Heung Dong, Lee Joon Soo
Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Republic of Korea.
Brain Dev. 2011 Sep;33(8):672-7. doi: 10.1016/j.braindev.2010.11.005. Epub 2010 Dec 13.
Corpus callosotomy (CC) is a palliative surgical procedure to control atonic, tonic, or generalized tonic-clonic seizure in Lennox-Gastaut syndrome (LGS). Here, we report patients with LGS who underwent resective surgery, following CC better delineating the presumed seizure foci localized in one hemisphere.
We retrospectively reviewed seven patients with LGS who underwent CC and subsequent cortical resection. The median follow-up duration after lobectomy was 20 months (range, 15-54 months) and three patients had follow-up periods over 24 months. The findings of video electroencephalography (EEG) monitoring, structural and functional neuroimagings were compared between pre- and post-CC.
Four patients had Engel class I and one patient had Engel class II outcomes following cortical resection; post-CC, compared to pre-CC, showed better localized ictal/interictal epileptiform discharges in the unilateral frontal area in two patients, in the unilateral parieto-temporo-occipital areas in one patient and in the unilateral fronto-temporal areas in the remaining two patients. Two patients had Engel Class III outcome following cortical resection; post-CC EEG continued to show multifocal epileptiform discharges but predominantly arising from a unilateral frontal area. Following CC, positron emission tomography showed localized glucose hypometabolism of which location was concordant with post-CC EEG abnormalities in all patient. Similarly, ictal/interictal single photon emission computed tomography also showed localized abnormalities concordant with post-CC EEG abnormalities in five of the six patients. Pathological assessment revealed cortical dysplasia in six patients, whereas no pathological abnormality was found in the remaining patient, who obtained Engel Class I outcome following cortical resection.
CC could change EEG findings, glucose metabolisms and cerebral blood flows, and it is sometimes helpful in delineating the primary seizure focus in patients with LGS.
胼胝体切开术（CC）是一种姑息性外科手术，用于控制 Lennox-Gastaut 综合征（LGS）中的失张力性、强直性或全身性强直阵挛性癫痫发作。在此，我们报告了接受切除性手术的 LGS 患者，在 CC 术后能更好地明确推测位于一个半球的癫痫病灶。
我们回顾性分析了 7 例接受 CC 及后续皮质切除术的 LGS 患者。肺叶切除术后的中位随访时间为 20 个月（范围 15 - 54 个月），3 例患者的随访期超过 24 个月。比较了 CC 术前和术后的视频脑电图（EEG）监测、结构和功能神经影像学检查结果。
4 例患者在皮质切除术后达到 Engel I 级，1 例患者达到 Engel II 级；与 CC 术前相比，术后 2 例患者在单侧额叶区域、1 例患者在单侧顶颞枕区域以及其余 2 例患者在单侧额颞区域的发作期/发作间期癫痫样放电定位更佳。2 例患者在皮质切除术后达到 Engel III 级；CC 术后 EEG 仍显示多灶性癫痫样放电，但主要起源于单侧额叶区域。CC 术后，正电子发射断层扫描显示局部葡萄糖代谢减低，其位置与所有患者的 CC 术后 EEG 异常一致。同样，在 6 例患者中的 5 例，发作期/发作间期单光子发射计算机断层扫描也显示与 CC 术后 EEG 异常一致的局部异常。病理评估显示 6 例患者存在皮质发育异常，而其余 1 例患者未发现病理异常，该患者在皮质切除术后达到 Engel I 级。
CC 可改变 EEG 表现、葡萄糖代谢和脑血流，有时有助于明确 LGS 患者的原发性癫痫病灶。
