Hwang Jun Kyu, Kim Dong-Seok
Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2019 May;62(3):336-343. doi: 10.3340/jkns.2019.0031. Epub 2019 May 1.
Epilepsy surgery revealed dramatically improved seizure outcomes over medical therapy in drug-resistant epilepsy patients. Children with epilepsy, however, have multiple epileptic focuses which require multilobar resection for better seizure outcome. Multilobar resection has not only the several severe surgical complications, such as hydrocephalus and shunt-related craniosynostosis, due to intracranial volume reduction. Isolation method (disconnection surgery) was progressively studied over epileptic focus removal (resective surgery) for seizure control. This concept was first introduced for functional hemispherotomy, and its primary principle is to preserve the vital vascularized brain that is functionally disconnected from the contralateral healthy brain. Currently in most epilepsy centers, the predominant disconnection surgical methods, including functional hemispherotomy, are continually being refined and are showing excellent results. They allow the functional isolation of the hemisphere or multi-lobe, affected by severe epilepsy. This review describes recent findings concerning the indication, surgical technique, seizure outcome and complications in several disconnection surgeries including the functional hemispherotomy for refractory pediatric epilepsy.
癫痫手术显示，对于耐药性癫痫患者，其癫痫发作结果比药物治疗有显著改善。然而，患有癫痫的儿童有多个癫痫病灶，需要进行多叶切除才能更好地控制癫痫发作。由于颅内体积减小，多叶切除不仅会引发多种严重的手术并发症，如脑积水和分流相关的颅骨缝早闭。为了控制癫痫发作，人们对隔离方法（离断手术）与癫痫病灶切除（切除性手术）进行了对比研究。这一概念最初是为功能性大脑半球切除术引入的，其主要原则是保留与对侧健康大脑功能分离的重要血管化脑组织。目前，在大多数癫痫中心，包括功能性大脑半球切除术在内的主要离断手术方法正在不断完善，并取得了优异的效果。它们能够实现受严重癫痫影响的半球或多叶的功能隔离。这篇综述描述了包括功能性大脑半球切除术在内的几种离断手术在难治性小儿癫痫的适应症、手术技术、癫痫发作结果和并发症方面的最新研究结果。
