Department of Epileptology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
Seizure. 2013 Sep;22(7):493-501. doi: 10.1016/j.seizure.2013.04.020. Epub 2013 May 25.
Resection of the seizure focus leads to sustained seizure-freedom in intractable focal epilepsy in up to 80% of selected populations. However, surgery fails to help in a considerable proportion of patients. Reevaluation and reoperation may be considered in a selected group of patients with an unfavorable postsurgical outcome. Here, we reviewed 15 case series on reoperation after failed resective epilepsy surgery in adults in order to identify factors associated with a good chance of benefitting from a second operation.
Literature review of case series describing the outcome of epilepsy surgical re-operations.
Overall, 3.8-14% of all patients who had resective epilepsy surgery underwent a second operation. A total of 402 reoperated patients were included. Reoperation was performed in average between 2 and 5.5 years after the first surgery. 36.6% of all patients were seizure-free with a minimal follow-up of 6 months to 4 years after the second operation. Postsurgical complications were observed in 13.5% and mainly consisted of visual field defects and, less frequently, of hemiparesis. The causes of failed first epilepsy surgery were heterogeneous and included incorrect localization or incomplete resection of the seizure focus, presence of additional seizure foci or progression of the underlying disease. Some features appear to indicate successful reoperation, such as concordance of postsurgical imaging and electroclinical findings as well as absence of brain trauma and cerebral infection prior to epilepsy onset.
Reoperation after thorough assessment of all available clinical, imaging and EEG findings can be an efficacious and reasonably safe treatment option which can achieve sustained seizure control after failed resective epilepsy surgery.
在选择的人群中，切除致痫灶可使 80%左右的难治性局灶性癫痫持续无发作。然而，相当一部分患者手术无效。在术后结果不利的患者中，可考虑重新评估和再次手术。在这里，我们回顾了 15 项关于成人手术失败后再次手术的病例系列研究，以确定与二次手术获益机会相关的因素。
对描述癫痫手术再次手术结果的病例系列文献进行回顾。
总体而言，所有接受过切除性癫痫手术的患者中有 3.8-14%接受了第二次手术。共纳入 402 例再次手术的患者。第二次手术平均在第一次手术后 2-5.5 年进行。所有患者中有 36.6%在第二次手术后 6 个月至 4 年的最小随访时间内无发作。术后并发症在 13.5%的患者中观察到，主要包括视野缺损，较少见的偏瘫。第一次癫痫手术失败的原因多种多样，包括致痫灶定位或切除不完全、存在额外的致痫灶或潜在疾病进展。一些特征似乎表明再次手术成功，例如术后影像学和临床电生理检查结果一致，以及癫痫发作前无颅脑创伤和脑感染。
在彻底评估所有可用的临床、影像学和 EEG 发现后进行再次手术，是一种有效的、合理安全的治疗选择，可以在切除性癫痫手术后失败的情况下实现持续的癫痫控制。
