Mathon B, Bédos-Ulvin L, Baulac M, Dupont S, Navarro V, Carpentier A, Cornu P, Clemenceau S
Department of neurosurgery, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Department of epileptology, groupe hospitalier universitaire de La Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Rev Neurol (Paris). 2015 Feb;171(2):141-56. doi: 10.1016/j.neurol.2014.09.010. Epub 2014 Dec 29.
The aim of this article was to review and evaluate the published literature related to the outcome of epilepsy surgery, while placing it in an historical perspective, and to describe the future prospects in this field.
Temporal lobe surgery achieves seizure freedom in about 70% of cases. Seizure outcome is similar in the pediatric population. Extratemporal resections impart good results to 40% to 60% of patients, with a better prognosis in the case of frontal lobe surgery. Pediatric hemispherotomy leads to seizure control in about 80% of children. Radiosurgery used as a treatment for temporal mesial epilepsy has an outcome quite similar to that obtained with surgical resection, but provides a neuropsychological advantage. Radiosurgery is also effective in 60% of children treated for seizures related to hypothalamic hamartoma. Regarding palliative surgery, callosotomy and multiple subpial transections show satisfactory outcomes in over 60% of cases. Neuromodulation techniques (vagus nerve stimulation and bilateral stimulation of the anterior nucleus of the thalamus) allow a 50% reduction of seizures in half of patients.
Transcranial magnetic stimulation combined with electroencephalography seems a promising technique because of its diagnostic, prognostic and therapeutic applications. Transcranial ultrasound stimulation, which can reversibly control neuronal activity, is also under consideration. Concerning neuromodulation, trigeminal nerve stimulation may become an alternative to vagus nerve stimulation; while other targets of deep brain stimulation are being evaluated. Also, the possibility of coupling SEEG seizure focus detection with concomitant laser or radiofrequency focus destruction is under development.
Constant evolution of epilepsy surgery has improved patient outcomes over time. Current research and development axes suggest the continuation of this trend and a reduction of the invasiveness of surgical procedures.
本文旨在回顾和评估已发表的与癫痫手术结果相关的文献，将其置于历史背景中，并描述该领域的未来前景。
颞叶手术在约70%的病例中可实现癫痫发作自由。儿童患者的癫痫发作结果相似。颞叶外切除术使40%至60%的患者获得良好效果，额叶手术的预后更好。小儿大脑半球切除术可使约80%的儿童癫痫得到控制。用于治疗颞叶内侧癫痫的放射外科手术的结果与手术切除相当，但具有神经心理学优势。放射外科手术对60%接受治疗的与下丘脑错构瘤相关癫痫发作的儿童也有效。关于姑息性手术，胼胝体切开术和多处软膜下横切术在超过60%的病例中显示出令人满意的结果。神经调节技术（迷走神经刺激和丘脑前核双侧刺激）可使一半患者的癫痫发作减少50%。
经颅磁刺激结合脑电图因其诊断、预后和治疗应用似乎是一种有前景的技术。能够可逆地控制神经元活动的经颅超声刺激也在考虑之中。关于神经调节，三叉神经刺激可能成为迷走神经刺激的替代方法；同时正在评估其他深部脑刺激靶点。此外，将立体定向脑电图癫痫病灶检测与伴随的激光或射频病灶破坏相结合的可能性也在开发中。
随着时间的推移，癫痫手术的不断发展改善了患者的治疗效果。当前的研究和发展方向表明这一趋势将持续，并降低手术的侵入性。
