1Department of Neurologic Surgery.
2Mayo Clinic Neuro-Informatics Laboratory.
J Neurosurg. 2018 Apr;128(4):1158-1164. doi: 10.3171/2016.12.JNS162096. Epub 2017 Jun 23.
OBJECTIVE Temporal lobectomy is a well-established treatment modality for the management of medically refractory epilepsy in appropriately selected patients. The aim of this study was to assess 30-day morbidity and mortality after temporal lobectomy in cases registered in a national database. METHODS A retrospective cohort analysis was conducted using a multiinstitutional surgical registry compiled between 2006 and 2014. The authors identified patients who underwent anterior temporal lobectomy and/or amygdalohippocampectomy for a primary diagnosis of intractable epilepsy. Univariate and multivariable analyses with regard to patient demographics, comorbidities, operative characteristics, and 30-day outcomes were applied. RESULTS A total of 216 patients were included in the study. The median age was 38 years and 46% of patients were male. The median length of stay was 3 days and the 30-day mortality rate was 1.4%. Fourteen patients (6.5%) developed at least one major complication. Return to the operating room was observed in 7 patients (3.2%). Readmission within 30 days and discharge to a location other than home were available for 2011-2014 (n = 155) and occurred in 11% and 10.3% of patients, respectively. Multivariable regression analysis revealed that increasing age was an independent predictor of discharge disposition other than home and that male sex was a significant risk factor for the development of a major complication. Interestingly, the presence of the attending neurosurgeon and a resident during the procedure was significantly associated with decreased odds of prolonged length of stay (i.e., > 75th percentile [5 days]) and discharge to a location other than home. CONCLUSIONS Using a multiinstitutional surgical registry, 30-day outcome data after temporal lobectomy for medically intractable epilepsy demonstrates a mortality rate of 1.4%, a major complication rate of 6.5%, and a readmission rate of 11%. Temporal lobectomy is an extremely effective therapy for seizures originating there-however, surgical intervention must be weighed against its morbidity and mortality outcomes.
目的 颞叶切除术是一种成熟的治疗方法，适用于适当选择的药物难治性癫痫患者。本研究旨在评估在国家数据库中登记的病例接受颞叶切除术 30 天后的发病率和死亡率。
方法 本研究采用回顾性队列分析，使用 2006 年至 2014 年间多机构手术登记处的数据。作者确定了因难治性癫痫行前颞叶切除术和/或杏仁核海马切除术的患者。应用单变量和多变量分析患者的人口统计学、合并症、手术特征和 30 天结果。
结果 共纳入 216 例患者。中位年龄为 38 岁，46%为男性。中位住院时间为 3 天，30 天死亡率为 1.4%。14 例（6.5%）至少发生了一种主要并发症。7 例（3.2%）患者需要再次手术。2011-2014 年有 2011-2014 年（n = 155）的患者出现了 30 天内再入院和出院至非家庭住址的情况，分别占 11%和 10.3%。多变量回归分析显示，年龄增长是出院至非家庭住址的独立预测因素，而男性是发生主要并发症的显著危险因素。有趣的是，手术期间主治神经外科医生和住院医生的存在与延长住院时间（即>第 75 百分位数[5 天]）和出院至非家庭住址的可能性降低显著相关。
结论 使用多机构手术登记处，对药物难治性癫痫患者行颞叶切除术 30 天后的结果数据显示，死亡率为 1.4%，主要并发症发生率为 6.5%，再入院率为 11%。颞叶切除术是治疗起源于该处的癫痫的一种非常有效的治疗方法——然而，手术干预必须权衡其发病率和死亡率。
