Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Neurosurgery. 2012 Mar;70(3):684-92. doi: 10.1227/NEU.0b013e318235183d.
There is still some reluctance to refer pediatric patients for epilepsy surgery, despite evidence of success in retrospective series.
To describe surgical experience and long-term outcome in pediatric temporal lobe epilepsy (TLE) at a single institution.
Retrospective review of pediatric (<18-years-old) TLE patients who underwent surgery between November 1996 and December 2006 at Cleveland Clinic Epilepsy Center. Cox proportional hazard modeling was used to assess outcome predictors.
One hundred thirty pediatric patients met study criteria. Mean time between seizure onset and surgery was 6.3 years. Invasive evaluation was used in 32 patients (24.5%). Hippocampal sclerosis was present in 70 patients (53.8%), either alone or associated in dual pathology. The complication rate was 7%. The seizure-freedom rates at 1, 2, 5, and 12 years were 76%, 72%, 54%, and 41%, respectively (Kaplan-Meier). With the use of the Engel outcome classification, 98 (75.3%) patients were class I, 11 (8.5%) class II, 9 (7%) class III, and 12 (9.2%) were class IV at last follow-up. Only 4 (3.1%) patients underwent reoperations. Antiepileptic drugs (AEDs) were discontinued in 36 patients (28.3%) in a mean period of 18 months (SD ± 17 months; range, 6-102 months). Although left-sided resection, lower number of preoperative AED trials (≤ 4), and tumor pathology correlated with favorable seizure outcomes, extensive surgical resection remained the only significant outcome predictor after multivariate analysis (P = .007; HR = 0.13 [95% confidence interval 0.007-0.64]).
Careful selection of surgical candidates by multidisciplinary evaluations is required. Long-term seizure control is achieved successfully with acceptable low complication rates.
尽管回顾性系列研究表明手术治疗取得了成功，但仍有一些人不愿将儿科患者转介进行癫痫手术。
描述单一机构内儿科颞叶癫痫（TLE）患者的手术经验和长期结果。
对 1996 年 11 月至 2006 年 12 月克利夫兰诊所癫痫中心接受手术的儿科（<18 岁）TLE 患者进行回顾性分析。使用 Cox 比例风险模型评估预后预测因素。
130 名儿科患者符合研究标准。从发病到手术的平均时间为 6.3 年。32 名患者（24.5%）进行了有创评估。70 名患者（53.8%）存在海马硬化，要么单独存在，要么存在双重病变。并发症发生率为 7%。1、2、5 和 12 年的无癫痫发作率分别为 76%、72%、54%和 41%（Kaplan-Meier）。根据 Engel 结果分类，98 名（75.3%）患者为 I 级，11 名（8.5%）为 II 级，9 名（7%）为 III 级，12 名（9.2%）为 IV 级。最后一次随访时，仅 4 名（3.1%）患者再次手术。36 名（28.3%）患者平均在 18 个月（SD±17 个月；范围 6-102 个月）停用抗癫痫药物（AEDs）。尽管左侧切除、术前 AED 试验次数较少（≤4 次）和肿瘤病理学与良好的癫痫发作结果相关，但多变量分析后，广泛的手术切除仍然是唯一显著的预后预测因素（P=0.007；HR=0.13[95%置信区间 0.007-0.64]）。
需要通过多学科评估仔细选择手术候选者。通过可接受的低并发症率，成功实现了长期的癫痫控制。
