Epilepsy Research Group, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden.
Department of Clinical Neurophysiology, Uppsala University Hospital, Uppsala, Sweden.
J Neurol Neurosurg Psychiatry. 2014 Jul;85(7):716-20. doi: 10.1136/jnnp-2013-306465. Epub 2013 Nov 29.
In some patients who undergo presurgical workup for drug-resistant epilepsy invasive seizure monitoring is needed to define the seizure onset zone and delineate eloquent cortex. Such procedures carry risks for complications causing permanent morbidity and even mortality. In this study, prospective data on complications in a national population-based sample were analysed.
Complication data from the prospective Swedish National Epilepsy Surgery Register were analysed for 271 patients in whom therapeutic surgery was preceded by invasive monitoring 1996-2010.
Complications occurred in 13/271 patients (4.8%). Subdural grids carried the highest risk of complications (7.4%). There was no surgical mortality or permanent morbidity. Subdural haematomas were most common (n=7) followed by epidural haematomas (n=3). Valproate treatment and having a haematoma was associated with an OR of 1.53 (CI 0.38 to 6.12) compared to having a haematoma without valproate treatment. Having a complication during invasive monitoring was associated with a significant OR of 6.27 (CI 1.32 to 29.9) of also having a complication at therapeutic surgery compared to the risk of having a complication only at surgery.
In this prospective population-based epilepsy surgery series, the most common complications were haematomas, and subdural grids carried the highest risk. Close supervision and rapid interventions led to avoidance of permanent morbidity. The clinical implications of the slightly increased risk of haematomas with valproate treatment needs further investigation as does the finding of an increased risk for complications at epilepsy surgery for patients who had a complication during invasive monitoring.
在一些需要进行术前药物难治性癫痫侵入性监测以确定癫痫发作起始区和描绘功能区的患者中，此类程序存在导致永久性发病率甚至死亡率的并发症风险。本研究分析了全国基于人群的样本中并发症的前瞻性数据。
对 1996 年至 2010 年间进行侵入性监测的 271 例接受治疗性手术的患者的前瞻性瑞典国家癫痫手术登记处并发症数据进行了分析。
271 例患者中有 13 例（4.8%）发生并发症。硬膜下网格的并发症风险最高（7.4%）。无手术死亡或永久性发病率。最常见的并发症是硬膜下血肿（n=7），其次是硬膜外血肿（n=3）。与未使用丙戊酸治疗且有血肿的患者相比，使用丙戊酸治疗和有血肿的患者的 OR 为 1.53（95%CI 0.38 至 6.12）。在侵入性监测期间发生并发症与在治疗性手术时也发生并发症的显著 OR 相关，风险比为 6.27（95%CI 1.32 至 29.9）。
在本前瞻性基于人群的癫痫手术系列中，最常见的并发症是血肿，硬膜下网格的风险最高。密切监测和快速干预避免了永久性发病率。丙戊酸治疗与血肿风险略有增加的临床意义需要进一步研究，以及在侵入性监测期间发生并发症的患者在癫痫手术时并发症风险增加的发现也需要进一步研究。
