Barba Carmen, Specchio Nicola, Guerrini Renzo, Tassi Laura, De Masi Salvatore, Cardinale Francesco, Pellacani Simona, De Palma Luca, Battaglia Domenica, Tamburrini Gianpiero, Didato Giuseppe, Freri Elena, Consales Alessandro, Nozza Paolo, Zamponi Nelia, Cesaroni Elisabetta, Di Gennaro Giancarlo, Esposito Vincenzo, Giulioni Marco, Tinuper Paolo, Colicchio Gabriella, Rocchi Raffaele, Rubboli Guido, Giordano Flavio, Lo Russo Giorgio, Marras Carlo Efisio, Cossu Massimo
Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy.
Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy.
Epilepsy Behav. 2017 Oct;75:151-157. doi: 10.1016/j.yebeh.2017.08.010. Epub 2017 Sep 15.
The objective of the study was to assess common practice in pediatric epilepsy surgery in Italy between 2008 and 2014.
A survey was conducted among nine Italian epilepsy surgery centers to collect information on presurgical and postsurgical evaluation protocols, volumes and types of surgical interventions, and etiologies and seizure outcomes in pediatric epilepsy surgery between 2008 and 2014.
Retrospective data on 527 surgical procedures were collected. The most frequent surgical approaches were temporal lobe resections and disconnections (133, 25.2%) and extratemporal lesionectomies (128, 24.3%); the most frequent etiologies were FCD II (107, 20.3%) and glioneuronal tumors (105, 19.9%). Volumes of surgeries increased over time independently from the age at surgery and the epilepsy surgery center. Engel class I was achieved in 73.6% of patients (range: 54.8 to 91.7%), with no significant changes between 2008 and 2014. Univariate analyses showed a decrease in the proportion of temporal resections and tumors and an increase in the proportion of FCDII, while multivariate analyses revealed an increase in the proportion of extratemporal surgeries over time. A higher proportion of temporal surgeries and tumors and a lower proportion of extratemporal and multilobar surgeries and of FCD were observed in low (<50surgeries/year) versus high-volume centers. There was a high variability across centers concerning pre- and postsurgical evaluation protocols, depending on local expertise and facilities.
This survey reveals an increase in volume and complexity of pediatric epilepsy surgery in Italy between 2008 and 2014, associated with a stable seizure outcome.
本研究的目的是评估2008年至2014年间意大利儿科癫痫手术的常见做法。
对九个意大利癫痫手术中心进行了一项调查，以收集有关2008年至2014年间儿科癫痫手术的术前和术后评估方案、手术干预的数量和类型以及病因和癫痫发作结果的信息。
收集了527例手术的回顾性数据。最常见的手术方法是颞叶切除术和离断术（133例，25.2%）和颞叶外病损切除术（128例，24.3%）；最常见的病因是II型局灶性皮质发育不良（FCD II，107例，20.3%）和神经胶质神经元肿瘤（105例，19.9%）。手术量随时间增加，与手术年龄和癫痫手术中心无关。73.6%的患者达到Engel I级（范围：54.8%至91.7%），2008年至2014年间无显著变化。单因素分析显示颞叶切除术和肿瘤的比例下降，而FCDII的比例增加，而多因素分析显示随着时间的推移颞叶外手术的比例增加。与高手术量中心相比，低手术量中心（每年<50例手术）的颞叶手术和肿瘤比例更高，颞叶外和多叶手术以及FCD的比例更低。各中心术前和术后评估方案存在很大差异，这取决于当地的专业知识和设施。
这项调查显示，2008年至2014年间意大利儿科癫痫手术的数量和复杂性有所增加，同时癫痫发作结果稳定。
