Kawai Kensuke
Department of Neurosurgery and Epilepsy Center, NTT Medical Center Tokyo.
Neurol Med Chir (Tokyo). 2015;55(5):357-66. doi: 10.2176/nmc.ra.2014-0414. Epub 2015 Apr 28.
This article reviews the current status of surgical treatment of epilepsy and introduces the ongoing challenges. Seizure outcome of resective surgery for focal seizures associated with focal lesions is satisfactory. Particularly for mesial temporal lobe epilepsy, surgical treatment should be considered from the earlier stage of the disease. Meanwhile, surgical outcome in nonlesional extratemporal lobe epilepsy is still to be improved using various approaches. Disconnective surgeries reduce surgical complications of extensive resections while achieving equivalent or better seizure outcomes. Multiple subpial transection is still being modified expecting a better outcome by transection to the vertical cortices along the sulci- and multi-directional transection from a single entry point. Hippocampal transection is expected to preserve memory function while interrupting the abnormal epileptic synchronization. Proper selection or combination of subdural and depth electrodes and a wide-band analysis of electroencephalography may improve the accurate localization of epileptogenic region. Patients for whom curative resective surgery is not indicated because of generalized or bilateral multiple nature of their epilepsies, neuromodulation therapies are options of treatment which palliate their seizures.
本文回顾了癫痫外科治疗的现状，并介绍了当前面临的挑战。与局灶性病变相关的局灶性癫痫发作的切除性手术的癫痫发作结果令人满意。特别是对于内侧颞叶癫痫，应在疾病的早期阶段就考虑手术治疗。同时，使用各种方法仍有待改善非病变性颞叶外癫痫的手术结果。离断性手术减少了广泛切除的手术并发症，同时实现了等效或更好的癫痫发作结果。多处软膜下横切术仍在改进中，期望通过沿着脑沟垂直切开皮质以及从单个入口点进行多方向切开获得更好的结果。海马横切术有望在中断异常癫痫同步的同时保留记忆功能。正确选择或组合硬膜下电极和深部电极以及对脑电图进行宽带分析可能会改善癫痫源区的精确定位。对于因癫痫的全身性或双侧多发性而不适合进行根治性切除手术的患者，神经调节疗法是减轻其癫痫发作的治疗选择。
