Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria.
Neurosurg Focus. 2013 Jun;34(6):E10. doi: 10.3171/2013.3.FOCUS1362.
Outcomes following functional hemispherotomy in patients with drug-resistant epilepsy have been well described. However, studies reporting long-term longitudinal outcomes after subhemispheric disconnective epilepsy surgery are still limited.
The authors conducted a retrospective review of prospectively collected data of 10 children who underwent temporoparietooccipital (TPO) disconnective surgery at the Vienna Pediatric Epilepsy Center.
There were 3 males and 7 females (median age 8.7 years; range 4.2-22.1 years). The affected hemisphere was the left in 3 patients and the right in 7. The patients' median age at seizure onset was 3.0 years (range 0.2-8.3 years). The median duration of epilepsy before surgery was 5.2 years (range 1.3-17.2 years). The underlying pathology was TPO malformation of cortical development in 5 patients, and venous infarction, posterior hemispheric quadrant atrophy, Sturge-Weber syndrome, cortical involvement of a systemic lupus erythematosus, and gliosis after cerebral tumor treatment in 1 each. In 6 children, a pure TPO disconnection was performed; in 2 patients, the temporal lobe was resected and parietooccipital disconnection was performed. The 2 remaining patients had had previous epilepsy surgery that was extended to a TPO disconnection: disconnection of the occipital lobe (n = 1) and resection of the temporal lobe (n = 1). The authors encountered no complications while performing surgery. No patient needed blood replacement therapy. No patient developed CSF disturbances that warranted treatment. Nine of 10 patients are currently seizure free since surgery (Wieser Class 1a) at a median follow-up time of 2.1 years (range 4 months to 8.1 years).
Temporoparietooccipital disconnection is a safe and effective motor-sparing epilepsy surgery in selected cases. Technical adjuncts facilitate a better intraoperative visualization and orientation, thereby enabling a less invasive approach than previously suggested.
功能性大脑半球切开术治疗耐药性癫痫的疗效已有大量报道。然而，关于次半球离断性癫痫手术后长期纵向结果的研究仍然有限。
作者对维也纳儿科癫痫中心 10 例接受颞顶枕（TPO）离断性手术的儿童前瞻性采集数据进行了回顾性分析。
3 例为男性，7 例为女性（中位年龄 8.7 岁；范围 4.2-22.1 岁）。病变半球在 3 例中为左侧，在 7 例中为右侧。患者的首发年龄中位数为 3.0 岁（范围 0.2-8.3 岁）。手术前癫痫的中位持续时间为 5.2 年（范围 1.3-17.2 年）。潜在病理学为皮质发育 TPO 畸形 5 例，静脉梗死、后半球象限萎缩、Sturge-Weber 综合征、系统性红斑狼疮皮质受累、脑肿瘤治疗后神经胶质增生各 1 例。6 例患儿行单纯 TPO 离断术，2 例患儿行颞叶切除术及顶枕叶离断术，其余 2 例患儿先前的癫痫手术扩展至 TPO 离断术：枕叶离断术（1 例）和颞叶切除术（1 例）。作者在手术过程中未遇到任何并发症。无患者需要输血治疗。无患者出现需要治疗的 CSF 紊乱。10 例患者中有 9 例术后无癫痫发作（Wieser 分级 1a），中位随访时间为 2.1 年（范围 4 个月至 8.1 年）。
在选择病例中，颞顶枕离断术是一种安全有效的、保留运动功能的癫痫手术。技术辅助可以更好地进行术中可视化和定向，从而实现比先前建议的更具侵袭性的手术方法。
