Division of Pediatric Neurosurgery, Rainbow Babies and Children's Hospital, The Neurological Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
World Neurosurg. 2013 Sep-Oct;80(3-4):396-8. doi: 10.1016/j.wneu.2012.03.020. Epub 2012 Apr 3.
The history of surgical treatment for hemispheric epilepsy is rich with colorful twists and turns. The authors trace the evolution of the surgical treatment of hemispheric epilepsy from radical anatomic resections to current less invasive disconnection procedures. Anatomic hemispherectomy (AH) was first described by Dandy in 1928 as a treatment for gliomas. The first report of this technique to control seizures was by McKenzie in 1938. AH gained wide popularity but began to fall out of favor after the description of superficial cerebral hemosiderosis in 1966. To reduce the morbidity and mortality associated with AH, Rasmussen introduced functional hemispherectomy in 1974. The technique of hemispherotomy was introduced in the 1990 s to minimize the extent of brain removal while maximizing the white matter disconnections. Thus, surgery for hemispheric epilepsy has undergone dramatic transformation since the technique was first introduced. Less invasive techniques have been developed to reduce surgical morbidity. Although optimal seizure control is best achieved with radical AH, the newer less invasive disconnection techniques appear to achieve near-comparable postoperative seizure control with a significantly lower rate of complications.
半球性癫痫的外科治疗历史丰富多彩，充满曲折。作者追溯了从根治性解剖性切除术到目前微创性离断术的半球性癫痫外科治疗演变历程。Dandy 于 1928 年首次描述了大脑半球切除术（anatomic hemispherectomy，AH），用于治疗神经胶质瘤。1938 年，McKenzie 首次报道了该技术可控制癫痫发作。1966 年描述了脑表浅铁沉积症后，AH 逐渐失宠。为了降低与 AH 相关的发病率和死亡率，Rasmussen 于 1974 年引入了功能性大脑半球切除术。大脑半球切开术于 20 世纪 90 年代引入，旨在最大限度地减少脑切除范围，同时最大限度地增加白质离断。因此，自该技术首次引入以来，半球性癫痫的外科治疗发生了巨大变化。已经开发出了微创技术来降低手术的发病率。尽管根治性 AH 可获得最佳的癫痫控制效果，但新型微创性离断技术在术后癫痫控制方面似乎具有相似的效果，而并发症发生率明显更低。
