Department of Neurosurgery, Christian Doppler Medical Center, Research Laboratory for Microsurgical Neuroanatomy, Paracelsus Medical University of Salzburg, Ignaz Harrerstrasse 79, Salzburg, Austria.
Epilepsia. 2013 Sep;54 Suppl 6:68-71. doi: 10.1111/epi.12282.
Although status epilepticus (SE) does not resemble a domain for neurosurgical indications in single occasions, a microneurosurgical procedure in patients with catastrophic epilepsy and status epilepticus should be considered as an ultimate ratio-choice in these patients. From a personal series of >600 epilepsy surgery procedures in a period from August 1, 1993 until March 13, 2013, 22 patients were identified with catastrophic epilepsy and all of them with at least one episode of status epilepticus. Five of the patients had surgery under ongoing status epilepticus. Twelve patients became seizure-free, two patients had >90% seizure reduction, seven patients >50% seizure reduction, and one patient was unchanged. No surgery-related complications in terms of permanent morbidity were ascertained in the presented series. In the subgroup of the five patients operated in the acute phase of SE one patient became seizure-free (Engel class. I), one showed Engel class II, two Engel class III, and one Engel class IV with no worthwhile improvement. Patients with catastrophic epilepsy including status epilepticus can benefit from resective epilepsy surgery, even with incomplete resection of the epileptogenic lesion.
尽管在个别情况下，癫痫持续状态（SE）并不类似于神经外科适应证的范畴，但对于患有灾难性癫痫和癫痫持续状态的患者，在这些患者中，应考虑进行微神经外科手术作为最终的治疗选择。在 1993 年 8 月 1 日至 2013 年 3 月 13 日期间，作者个人进行了超过 600 例癫痫手术，其中 22 例患者被诊断为灾难性癫痫，且所有患者均至少有一次癫痫持续状态发作。其中 5 例患者在持续癫痫状态下接受了手术。12 例患者无癫痫发作，2 例患者癫痫发作减少 90%以上，7 例患者癫痫发作减少 50%以上，1 例患者无变化。在本系列中未发现与手术相关的永久性发病率并发症。在 SE 急性阶段接受手术的 5 例患者亚组中，1 例患者无癫痫发作（Engel 分级 I），1 例患者为 Engel 分级 II，2 例患者为 Engel 分级 III，1 例患者为 Engel 分级 IV，无明显改善。包括癫痫持续状态在内的灾难性癫痫患者可以从切除性癫痫手术中获益，即使癫痫灶不完全切除。
