内镜辅助（经小骨窗开颅）胼胝体切开术联合前连合、海马连合及后连合切开术治疗Lennox-Gastaut综合征：一项评估其安全性和有效性的初步研究
Endoscopic-Assisted (Through a Mini Craniotomy) Corpus Callosotomy Combined With Anterior, Hippocampal, and Posterior Commissurotomy in Lennox-Gastaut Syndrome: A Pilot Study to Establish Its Safety and Efficacy.
作者信息
Chandra Sarat P, Kurwale Nilesh S, Chibber Sarabjit Singh, Banerji Jyotirmoy, Dwivedi Rekha, Garg Ajay, Bal Chandrashekhar, Tripathi Madhavi, Sarkar Chitra, Tripathi Manjari
机构信息
*Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India;‡Centre of Excellence for Epilepsy, New Delhi, India;§Department of Neurology, All India Institute of Medical Sciences, New Delhi, India;¶Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India;‖Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India;#Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Neurosurgery. 2016 May;78(5):743-51. doi: 10.1227/NEU.0000000000001060.
BACKGROUND
Corpus callosotomy is a palliative procedure especially for Lennox-Gastaut semiology without localization with drop attacks.
OBJECTIVE
To describe endoscopic-assisted complete corpus callosotomy combined with anterior, hippocampal, and posterior commissurotomy.
METHODS
Patients with drug refractory epilepsy having drop attacks as the predominant seizure type, bilateral abnormalities on imaging, and moderate to severe mental retardation were included. All underwent a complete workup (including magnetic resonance imaging).
RESULTS
Patients (n = 16, mean age 11.4 ± 6.4 years, range 6-19 years) had a mean seizure frequency of 24.5 ± 19.8/days (range 1-60) and a mean intelligence quotient of 25.23 ± 10.71. All had syndromic diagnosis of Lennox-Gastaut syndrome, with the following etiologies: hypoxic insult (10), lissencephaly (2), bilateral band heterotropia (2), and microgyria and pachygyria (2). Surgery included complete callosotomy and the section of anterior and posterior commissure by microscopic approach through a mini craniotomy (11) and endoscopic-assisted approach (5). Complications included meningitis (1), hyperammonemic encephalopathy (2), and acute transient disconnection (5). There was no mortality or long-term morbidity. Mean follow-up was 18 ± 4.7 months (range 16-27 months). Drop attacks stopped in all. Seizure frequency/duration decreased >90% in 10 patients and >50% in 5 patients, and increased in 1 patient. All patients attained presurgical functional levels in 3 to 6 months. Child behavior checklist scores showed no deterioration. Parental questionnaires reported 90% satisfaction attributed to the control of drop attacks. The series was compared retrospectively with an age/sex-matched cohort (where a callosotomy only was performed), and showed better outcome for drop attacks (P < .003).
CONCLUSION
This preliminary study demonstrated the efficacy and safety of complete callosotomy with anterior, hippocampal, and posterior commissurotomy in Lennox-Gastaut syndrome (drop attacks) with moderate to severe mental retardation.
背景
胼胝体切开术是一种姑息性手术，尤其适用于无跌倒发作定位的Lennox-Gastaut综合征。
目的
描述内镜辅助下完全胼胝体切开术联合前连合、海马连合和后连合切开术。
方法
纳入以跌倒发作为主要发作类型、影像学显示双侧异常且有中度至重度智力障碍的药物难治性癫痫患者。所有患者均接受了全面检查（包括磁共振成像）。
结果
患者（n = 16，平均年龄11.4±6.4岁，范围6 - 19岁）平均发作频率为24.5±19.8次/天（范围1 - 60次），平均智商为25.23±10.71。所有患者均被诊断为Lennox-Gastaut综合征，病因如下：缺氧性损伤（10例）、无脑回畸形（2例）、双侧带状异位（2例）、微小脑回和巨脑回（2例）。手术包括完全胼胝体切开术以及通过微型开颅显微镜手术（11例）和内镜辅助手术（5例）切断前连合和后连合。并发症包括脑膜炎（1例）、高氨血症性脑病（2例）和急性短暂性分离综合征（5例）。无死亡病例或长期并发症。平均随访时间为18±4.7个月（范围16 - 27个月）。所有患者的跌倒发作均停止。10例患者的发作频率/持续时间降低>90%，5例患者降低>50%，1例患者发作频率增加。所有患者在3至6个月内恢复到术前功能水平。儿童行为检查表评分未显示恶化。家长问卷调查显示，90%的家长对跌倒发作得到控制表示满意。该系列研究与年龄/性别匹配的队列（仅进行胼胝体切开术）进行回顾性比较，结果显示在跌倒发作方面预后更好（P <.003）。
结论
这项初步研究证明了在伴有中度至重度智力障碍的Lennox-Gastaut综合征（跌倒发作）中，完全胼胝体切开术联合前连合、海马连合和后连合切开术的有效性和安全性。
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