Fukuda Masafumi, Masuda Hiroshi, Shirozu Hiroshi, Ito Yosuke, Nakayama Yoko, Higashijima Takefumi, Fujii Yukihiko
a Department of Neurosurgery , Nishi-Niigata National Chuo Hospital , Niigata-City , Japan.
b Department of Neurosurgery , Brain Research Institute, University of Niigata , Niigata-City , Japan.
Neurol Res. 2017 Dec;39(12):1049-1055. doi: 10.1080/01616412.2017.1376471. Epub 2017 Sep 11.
Objectives There are three conceivable reasons for the failure of resective surgery for intractable epilepsy: incomplete resection of the epileptogenic zone including or overlapping with eloquent area (group A); incorrect determination of the epileptogenic zone prior to the first surgery (group B); and the development of a new epileptic focus after the first surgery (group C). We examined the relationship between the reason for failure of initial surgery and patient outcomes after repeated surgical resection. Methods The study included 18 patients (5.1%) underwent additional surgery after failure of the initial operation. Post-operative outcomes, complications and other clinical data were collected by retrospective chart review. Results Four patients (22.2%) were assigned to group A, 13 (72.2%) were assigned to group B, and 1 patient was assigned to group C (5.6%). Six patients (40.0%) were seizure-free for 2 or more years after additional surgery. In group B, 11 patients underwent additional resection of the cortex adjacent to the previously resected area and 2 underwent re-operation involving a site distant from the previously resected area; notably, the latter 2 patients did not achieve seizure-free status post-surgery. After the first operation, only one patient (group A) experienced transient paresis; after additional surgery, 10 of 18 patients (56%; 3 group A, 6 group B, and 1 group C) experienced various complications. Discussion Although additional resective surgery provided freedom from seizures in about 40% of the patients, it is important to weigh a high risk of complications against possible benefits when considering additional surgery.
目的 难治性癫痫切除性手术失败可能有三种原因：癫痫源区切除不完全，包括与功能区部分或全部重叠（A组）；首次手术前癫痫源区判定错误（B组）；首次手术后出现新的癫痫病灶（C组）。我们研究了初次手术失败原因与再次手术切除后患者预后之间的关系。方法 本研究纳入18例（5.1%）初次手术失败后接受再次手术的患者。通过回顾病历收集术后预后、并发症及其他临床资料。结果 4例（22.2%）患者属于A组，13例（72.2%）属于B组，1例（5.6%）属于C组。6例（40.0%）患者再次手术后2年或更长时间无癫痫发作。B组中，11例患者再次切除了先前切除区域附近的皮质，2例患者进行了远离先前切除区域的再次手术；值得注意的是，后2例患者术后未达到无癫痫发作状态。初次手术后，只有1例（A组）患者出现短暂性轻瘫；再次手术后，18例患者中有10例（56%；3例A组，6例B组，1例C组）出现了各种并发症。讨论 虽然再次切除性手术使约40%的患者摆脱了癫痫发作，但在考虑再次手术时，权衡高并发症风险与可能的获益非常重要。
