Great Ormond Street Hospital for Children NHS Trust, London, UK,
Curr Treat Options Neurol. 2012 Dec;14(6):620-9. doi: 10.1007/s11940-012-0203-8.
Surgery for refractory epilepsy in appropriately selected children is effective. The key factors influencing a good outcome are careful selection of candidates, early referral to pediatric epilepsy surgical unit, underlying neuropathology and the completeness of surgical resection of the seizure focus. Although the primary aim of a surgery is seizure freedom, benefits are also seen in cognitive development. Early prompt referral is therefore desired to optimise outcome. Focal resections involving the temporal and frontal lobes are the common resective procedures in children, with cortical malformations the most common underlying pathology. Hemispherectomy or multilobar procedures are more commonly performed in children younger than four years. Seizure free rates reach 60-80 %. The availability of newer techniques for presurgical evaluation, along with invasive intracranial electroencephalographic (EEG) recording, has facilitated surgical consideration. Resective surgery may also be beneficial for children who may appear to have bilateral or generalised clinical or EEG features associated with focal lesions on MRI. Vagal Nerve Stimulation (VNS) and corpus callosotomy are employed for selected candidates not suitable for resective surgery with good results.
对于适当选择的儿童，手术治疗难治性癫痫是有效的。影响良好结果的关键因素包括仔细选择患者、尽早转至儿科癫痫外科治疗单位、潜在神经病理学和致痫灶的完全切除程度。虽然手术的主要目标是无癫痫发作，但认知发育也有获益。因此，早期及时转诊是优化结果所必需的。涉及颞叶和额叶的局灶性切除术是儿童中常见的切除术，皮质畸形是最常见的潜在病理学。半球切除术或多叶切除术在 4 岁以下的儿童中更为常见。无癫痫发作率达到 60-80%。术前评估新技术的可用性，加上侵袭性颅内脑电图 (EEG) 记录，促进了手术的考虑。对于那些可能具有双侧或全身性临床或 EEG 特征，且 MRI 上存在局灶性病变的儿童，切除性手术可能也有益。对于不适合切除性手术的选定患者，迷走神经刺激 (VNS) 和胼胝体切开术也有良好的效果。
