致痫性内侧颞叶硬化的癫痫外科治疗失败：病理生理学综述。
Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology.
机构信息
Department of Neurosurgery, University of South Florida, Tampa, Florida 33606, USA.
出版信息
Neurosurg Focus. 2012 Mar;32(3):E9. doi: 10.3171/2011.12.FOCUS11318.
OBJECT
The object of the current study was to review the electrophysiology and pathological substrate of failed temporal lobe surgery in patients with mesial temporal sclerosis.
METHODS
A systematic review of the literature was performed for the years 1999-2010 to assess the cause of failure and to identify potential reoperation candidates.
RESULTS
Repeat electroencephalographic evaluation documenting ipsilateral temporal lobe onset was the most frequent cause for recurrent epileptogenesis, followed by contralateral temporal lobe seizures. Less frequently, surgical failures demonstrated an electroencephalogram that was compatible with extratemporal localization. The generation of occult or new epileptogenic zones as well as residual epileptogenic tissue could explain these findings.
CONCLUSIONS
The outcome of temporal lobe surgery for epilepsy is challenged by a somewhat consistent failure rate. Reoperation results in improved seizure control in properly selected patients. A detailed knowledge of the pathophysiology is beneficial for the reevaluation of these patients.
目的
本研究旨在回顾内侧颞叶硬化症患者颞叶手术失败的电生理学和病理学基础。
方法
对 1999 年至 2010 年的文献进行系统回顾，以评估失败的原因，并确定潜在的再次手术候选者。
结果
记录同侧颞叶起始的重复脑电图评估是复发性癫痫发生的最常见原因，其次是对侧颞叶癫痫发作。不太常见的是，手术失败的脑电图与颞外定位相吻合。隐匿性或新致痫区的产生以及残留的致痫组织可以解释这些发现。
结论
癫痫的颞叶手术结果受到相当一致的失败率的挑战。在适当选择的患者中，再次手术可改善癫痫控制。详细了解病理生理学对这些患者的重新评估是有益的。
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