Bansal Seema, Kim Andrew J, Berg Anne T, Koh Sookyong, Laux Linda C, Nangia Srishti, Millichap John J, Shaw Alexandra, Fisher Breanne, Dezort Catherine, DiPatri Arthur J, Alden Tord D, Nordli Douglas R
Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Pediatr Neurol. 2017 Jun;71:35-42. doi: 10.1016/j.pediatrneurol.2017.01.024. Epub 2017 Feb 7.
In children with abnormal imaging, single-stage epilepsy surgery is an attractive alternative to the two-stage approach that relies on invasive recording of seizures. Implanted electrodes carry risks of their own and extend hospitalization, but the efficacy of one-stage resections in a variety of pathologies and cerebral locations is not well established. We report our center's experience with single-stage epilepsy surgery guided by intraoperative electrocorticography (ECoG).
We retrospectively analyzed 130 consecutive patients who underwent single-stage epilepsy surgery before age 19 years and had at least a two-year follow-up. Intraoperative ECoG was available for review in 113. Patients were considered seizure-free if they were continuously Engel Class I up to the two-year postoperative mark. ECoG findings were classified according to the presence of interictal attenuation, spikes, both, or neither. Complications and hospital length of stay were evaluated.
Eighty percent of 130 patients were seizure-free at two years. All but one had an abnormal MRI. Patients with tumor had a better seizure outcome than patients with cortical malformation. Frontal resections had worse outcome, especially among tumors. Intraoperative ECoG revealed both attenuation and spikes in 48%, attenuation only in 23%, spikes only in 20%, and neither in 9%. The complication rate was 6.9%, with no major neurological complications. The average length of stay was 5.7 nights.
With ECoG-guided single-stage surgery, we achieved results comparable with other pediatric surgical series and with a low complication rate. An extensive two-stage approach may not be required when there is a lesion on imaging and other information is concordant, even when the MRI abnormality is subtle and unclearly delineated. Frontal foci may present a challenge because of their proximity to "eloquent" nonresectable cortex or critical structures.
对于影像学检查异常的儿童患者，单阶段癫痫手术是一种有吸引力的选择，可替代依赖发作期侵入性记录的两阶段手术方法。植入电极本身存在风险且会延长住院时间，但单阶段切除术在各种病理情况和脑区位置的疗效尚未明确。我们报告了我们中心在术中皮质脑电图（ECoG）引导下进行单阶段癫痫手术的经验。
我们回顾性分析了130例19岁前接受单阶段癫痫手术且至少随访两年的连续患者。其中113例患者有术中ECoG可供回顾。如果患者术后两年一直处于恩格尔一级，则视为无癫痫发作。根据发作间期衰减、棘波、两者都有或两者都无对ECoG结果进行分类。评估并发症和住院时间。
130例患者中有80%在两年时无癫痫发作。除1例患者外，其余患者MRI均异常。肿瘤患者的癫痫发作结果优于皮质发育畸形患者。额叶切除术的结果较差，尤其是肿瘤患者。术中ECoG显示既有衰减又有棘波的占48%，只有衰减的占23%，只有棘波的占20%，两者都无的占9%。并发症发生率为6.9%，无严重神经系统并发症。平均住院时间为5.7晚。
通过ECoG引导的单阶段手术，我们取得了与其他儿科手术系列相当的结果，且并发症发生率较低。当影像学上有病变且其他信息一致时，即使MRI异常细微且界限不清，可能也不需要广泛的两阶段手术方法。额叶病灶可能会带来挑战，因为它们靠近“明确功能”的不可切除皮质或关键结构。
