Fallah Aria, Weil Alexander G, Sur Samir, Miller Ian, Jayakar Prasanna, Morrison Glenn, Bhatia Sanjiv, Ragheb John
Departments of 1 Neurosurgery and.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
J Neurosurg Pediatr. 2015 Dec;16(6):675-80. doi: 10.3171/2015.4.PEDS14476. Epub 2015 Sep 4.
Pediatric brain tumors may be associated with medically intractable epilepsy for which surgery is indicated. The authors sought to evaluate the efficacy of epilepsy surgery for seizure control in pediatric patients with brain tumors.
The authors performed a retrospective review of consecutive patients undergoing resective epilepsy surgery related to pediatric brain tumors at Miami Children's Hospital between June 1986 and June 2014. Time-to-event analysis for seizure recurrence was performed; an "event" was defined as any seizures that occurred following resective epilepsy surgery, not including seizures and auras in the 1st postoperative week. The authors analyzed several preoperative variables to determine their suitability to predict seizure recurrence following surgery.
Eighty-four patients (47 males) with a mean age (± standard deviation) of 8.7 ± 5.5 years (range 0.5-21.6 years) were included. The study included 39 (46%) patients with gliomas, 20 (24%) with dysembryoplastic neuroepithelial tumors (DNETs), 14 (17%) with gangliogliomas, and 11 (13%) with other etiologies. Among the patients with gliomas, 18 were classified with low-grade glioma, 5 had oligodendroglioma, 6 had uncategorized astrocytoma, 3 had pilocytic astrocytoma, 3 had pleomorphic xanthoastrocytoma, 3 had glioblastoma, and 1 had gliomatosis cerebri. Seventy-nine (94.0%) resections were guided by intraoperative electrocorticography (ECoG). The mean time (± standard deviation) to seizure recurrence was 81.8 ± 6.3 months. Engel Class I outcome was achieved in 66 (78%) and 63 (75%) patients at 1 and 2 years' follow-up, respectively. Patients with ganglioglioma demonstrated the highest probability of long-term seizure freedom, followed by patients with DNETs and gliomas. In univariate analyses, temporal location (HR 1.75, 95% CI 0.26-1.27, p = 0.171) and completeness of resection (HR 1.69, 95% CI 0.77-3.74, p = 0.191) demonstrated a trend toward a longer duration of seizure freedom.
ECoG-guided epilepsy surgery for pediatric patients with brain tumors is highly effective. Tumors located in the temporal lobe and those in which a complete ECoG-guided resection is performed may result in a greater likelihood of long-term seizure freedom.
小儿脑肿瘤可能与药物难治性癫痫相关，对此需进行手术治疗。作者旨在评估癫痫手术对小儿脑肿瘤患者控制癫痫发作的疗效。
作者对1986年6月至2014年6月间在迈阿密儿童医院接受与小儿脑肿瘤相关的切除性癫痫手术的连续患者进行了回顾性研究。对癫痫复发进行了事件发生时间分析；“事件”定义为切除性癫痫手术后发生的任何癫痫发作，不包括术后第1周内的癫痫发作和先兆。作者分析了几个术前变量，以确定它们预测术后癫痫复发的适用性。
纳入84例患者（47例男性），平均年龄（±标准差）为8.7±5.5岁（范围0.5 - 21.6岁）。该研究包括39例（46%）胶质瘤患者、20例（24%）胚胎发育不良性神经上皮肿瘤（DNETs）患者、14例（17%）神经节胶质瘤患者和11例（13%）其他病因患者。在胶质瘤患者中，18例为低级别胶质瘤，5例为少突胶质细胞瘤，6例为未分类星形细胞瘤，3例为毛细胞型星形细胞瘤，3例为多形性黄色星形细胞瘤，3例为胶质母细胞瘤，1例为大脑胶质瘤病。79例（94.0%）切除手术由术中皮层脑电图（ECoG）引导。癫痫复发的平均时间（±标准差）为81.8±6.3个月。在1年和2年随访时，分别有66例（78%）和63例（75%）患者达到Engel I级结局。神经节胶质瘤患者实现长期无癫痫发作的概率最高，其次是DNETs患者和胶质瘤患者。在单因素分析中，颞叶位置（风险比1.75，95%置信区间0.26 - 1.27，p = 0.171）和切除完整性（风险比1.69，95%置信区间0.77 - 3.74，p = 0.191）显示出癫痫发作自由持续时间更长的趋势。
对于小儿脑肿瘤患者，ECoG引导的癫痫手术非常有效。位于颞叶的肿瘤以及通过ECoG引导进行完整切除的肿瘤可能导致长期无癫痫发作的可能性更大。
