Department of Pediatric Neurosurgery, A. Gemelli Hospital, Rome, Italy.
Depart-ment of Pediatric Neurology, A. Gemelli Hospital, Rome, Italy.
Neurosurgery. 2018 Apr 1;82(4):465-472. doi: 10.1093/neuros/nyx221.
Postoperative seizures (PSs) after neurosurgical operations are common but little is known about the role of surgical brain incision on their genesis. This topic has not been addressed so far.
To verify if the corticotomy affects the risk of PSs and postoperative epilepsy (PE) in children.
One hundred forty-three consecutive pediatric cases operated on for supratentorial lesions at the same institution in the last 15 yr have been retrospectively reviewed by dividing them into group A, 68 children who required brain corticotomy mainly for hemispheric tumors, and group B, 75 children treated through extracortical approaches mainly for suprasellar and optic tumors. Patients with possible "epileptic" biases, like preoperative seizures, were excluded.
No significant differences have been found between group A and B as far as incidence of PSs (11.7% vs 14.5%) and PE (4.5% vs 6.5%), timing, and type of seizures are concerned after a mean 6.8 yr follow-up. The size of corticotomy in group A (<3 cm2 vs >3 cm2) had no impact on epileptogenesis as well as the other variables considered in both groups (age, sex, extent of lesion resection).
This study shows that the surgical cortical "trauma" would not represent a risk factor for PSs and PE. According to the present analysis and the literature, other causes seem to be involved (namely, electrolytic imbalance and brain gliosis). This information is important for preoperative surgical planning and postoperative management. A validation by both adult series and prospective studies is needed.
神经外科手术后的癫痫发作（PS）很常见，但对于手术性脑切口在其发病机制中的作用知之甚少。这个问题至今尚未得到解决。
验证皮质切开术是否会增加儿童 PS 和术后癫痫（PE）的风险。
回顾性分析了 143 例在过去 15 年内因幕上病变在同一机构接受手术的连续儿科病例，将其分为 A 组（68 例，主要因半球肿瘤需要脑皮质切开术）和 B 组（75 例，主要通过皮质外途径治疗，主要为鞍上和视神经肿瘤）。排除术前有癫痫发作等可能存在“癫痫”倾向的患者。
A 组和 B 组在 PS（11.7%对 14.5%）和 PE（4.5%对 6.5%）的发生率、癫痫发作的时间和类型方面均无显著差异。平均随访 6.8 年后。A 组的皮质切开术大小（<3 cm2 对>3 cm2）以及两组考虑的其他变量（年龄、性别、病变切除程度）均对癫痫发作无影响。
本研究表明，手术性皮质“创伤”不是 PS 和 PE 的危险因素。根据目前的分析和文献，其他原因似乎也参与其中（即电解质失衡和脑胶质增生）。这些信息对于术前手术计划和术后管理很重要。需要通过成人系列和前瞻性研究来验证。
