Wyler A R, Hermann B P, Richey E T
Epi-Care Center, Baptist Memorial Hospital, University of Tennessee, Semmes-Murphey Clinic, Memphis.
J Neurosurg. 1989 Dec;71(6):815-9. doi: 10.3171/jns.1989.71.6.0815.
A total of 37 patients who failed epilepsy surgery were evaluated with magnetic resonance imaging and long-term scalp electroencephalographic monitoring before reoperation. Repeat surgery involved focal resections after initial focal resections (30 cases) or stereotactic lesions (one case), or focal resections following anterior corpus callosotomy (six cases). Patients with initial focal resections followed by enlargement of the original operative site had the most successful outcome, especially those with complex partial seizures of temporal lobe origin. The most common cause for poor outcome of the original operation in patients with temporal lobe epilepsy was insufficient hippocampal resection. Patients who were most likely to benefit from reoperation were: 1) those with initially incompletely resected structural lesions; 2) those who were initially evaluated with invasive ictal monitoring; and 3) those who underwent further resection of the initial operative site rather than resection of a different cortical region.
共有37例癫痫手术失败的患者在再次手术前接受了磁共振成像和长期头皮脑电图监测。再次手术包括在初次局灶性切除后进行局灶性切除（30例）或立体定向毁损术（1例），或在胼胝体前部切开术后进行局灶性切除（6例）。初次局灶性切除后扩大原手术部位的患者手术效果最佳，尤其是那些起源于颞叶的复杂部分性发作患者。颞叶癫痫患者原手术效果不佳的最常见原因是海马切除不充分。最有可能从再次手术中获益的患者为：1）最初结构性病变切除不完全的患者；2）最初接受侵入性发作期监测评估的患者；3）接受原手术部位进一步切除而非不同皮质区域切除的患者。
