Rubinger Luc, Hazrati Lili-Naz, Ahmed Raheel, Rutka James, Snead Carter, Widjaja Elysa
Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada.
Epilepsia. 2017 Mar;58(3):393-401. doi: 10.1111/epi.13667. Epub 2017 Jan 23.
There is some suggestion that microscopic infarct could be associated with invasive monitoring, but it is unclear if the microscopic infarct is also visible on imaging and associated with neurologic deficits. The aims of this study were to assess the rates of microscopic and macroscopic infarct and other major complications of pediatric epilepsy surgery, and to determine if these complications were higher following invasive monitoring.
We reviewed the epilepsy surgery data from a tertiary pediatric center, and collected data on microscopic infarct on histology and macroscopic infarct on postoperative computed tomography (CT) or magnetic resonance imaging (MRI) done one day after surgery and major complications.
Three hundred fifty-two patients underwent surgical resection and there was one death. Forty-two percent had invasive monitoring. Thirty patients (9%) had microscopic infarct. Univariable analyses showed that microscopic infarct was higher among patients with invasive monitoring relative to no invasive monitoring (20% vs. 0.5%, respectively, p < 0.001). Eighteen patients (5%) had macroscopic infarct on CT or MRI. Univariable analysis showed no significant difference in macroscopic infarct between invasive monitoring and no invasive monitoring (8% vs. 3%, respectively, p = 0.085). One patient with microscopic infarct had transient right hemiparesis, and two with both macroscopic and microscopic infarct had unexpected persistent neurologic deficits. Thirty-two major complications (9.1%) were reported, with no difference in major complications between invasive monitoring and no invasive monitoring (10% vs. 7%, p = 0.446). In the multivariable analysis, invasive monitoring increased the odds of microscopic infarct (odds ratio [OR] 15.87, p = 0.009), but not macroscopic infarct (OR 2.6, p = 0.173) or major complications (OR 1.4, p = 0.500), after adjusting for age at surgery, sex, age at seizure onset, operative type, and operative location.
Microscopic infarct was associated with invasive monitoring, and none of the patients had permanent neurologic deficits. Macroscopic infarct was not associated with invasive monitoring, and two patients with macroscopic infarct had persistent neurologic deficits.
有一些迹象表明微小梗死可能与侵入性监测有关，但尚不清楚微小梗死在影像学上是否也可见以及是否与神经功能缺损相关。本研究的目的是评估小儿癫痫手术中微小和宏观梗死以及其他主要并发症的发生率，并确定侵入性监测后这些并发症是否更高。
我们回顾了一家三级儿科中心的癫痫手术数据，并收集了术后一天进行的组织学微小梗死、术后计算机断层扫描（CT）或磁共振成像（MRI）上的宏观梗死以及主要并发症的数据。
352例患者接受了手术切除，1例死亡。42%的患者进行了侵入性监测。30例患者（9%）有微小梗死。单变量分析显示，与未进行侵入性监测的患者相比，进行侵入性监测的患者微小梗死发生率更高（分别为20%和0.5%，p < 0.001）。18例患者（5%）在CT或MRI上有宏观梗死。单变量分析显示，侵入性监测和未进行侵入性监测的患者宏观梗死发生率无显著差异（分别为8%和3%，p = 0.085）。1例有微小梗死的患者出现短暂性右侧偏瘫，2例既有宏观梗死又有微小梗死的患者出现意外的持续性神经功能缺损。报告了32例主要并发症（9.1%），侵入性监测和未进行侵入性监测的患者主要并发症发生率无差异（分别为10%和7%，p = 0.446）。在多变量分析中，在调整了手术年龄、性别、癫痫发作起始年龄、手术类型和手术部位后，侵入性监测增加了微小梗死的几率（比值比[OR] 15.87，p = 0.009），但未增加宏观梗死的几率（OR 2.6，p = 0.173）或主要并发症的几率（OR 1.4，p = 0.500）。
微小梗死与侵入性监测有关，且所有患者均无永久性神经功能缺损。宏观梗死与侵入性监测无关，2例有宏观梗死的患者出现持续性神经功能缺损。
