Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota.
Epilepsy Center, Cleveland Clinic, Cleveland, Ohio.
Epilepsia. 2019 Dec;60(12):2416-2427. doi: 10.1111/epi.16378. Epub 2019 Nov 2.
To examine longitudinal seizure and functional outcomes after hemispherectomy in adults and adolescents.
We reviewed 47 consecutive patients older than 16 years who underwent hemispherectomy between 1996 and 2016 at our center. Clinical, electroencephalographic (EEG), imaging, neuropsychological, surgical, and functional status data were analyzed.
Thirty-six patients were 18 years or older at surgery; 11 were aged between 16 and 18 years. Brain injury leading to hemispheric epilepsy occurred before 10 years of age in 41 (87%) patients. At a mean follow-up of 5.3 postoperative years (median = 2.9 years), 36 (77%) had Engel class I outcome. Longitudinal outcome analysis showed 84% seizure freedom (Engel IA) at 6 months, 76% at 2 years, and 76% at 5 years and beyond, with stable longitudinal outcomes up to 12 years from surgery. Multivariate analysis demonstrated that acute postoperative seizures and contralateral interictal spikes at 6-month follow-up EEG were associated with seizure recurrence. Patients who could walk unaided preoperatively and had no cerebral peduncle atrophy on brain magnetic resonance imaging were more likely to experience worsening of motor function postoperatively. Otherwise, postoperative ambulatory status and hand function were unchanged. Of the 19 patients who completed neuropsychological testing, 17 demonstrated stable or improved postoperative outcomes.
Hemispherectomy in adults is a safe and effective procedure, with seizure freedom rates and functional outcome similar to those observed in children.
研究成人和青少年行半脑切除术的纵向癫痫发作和功能结局。
我们回顾了 1996 年至 2016 年期间在我中心行半脑切除术的 47 例年龄大于 16 岁的连续患者。分析了临床、脑电图（EEG）、影像学、神经心理学、手术和功能状态数据。
36 例患者手术时年龄为 18 岁或以上；11 例患者年龄在 16 至 18 岁之间。41 例（87%）患者的半球性癫痫是由 10 岁前的脑损伤引起的。在术后平均随访 5.3 年（中位数=2.9 年）时，36 例（77%）患者的术后结果为 Engel Ⅰ级。纵向结局分析显示，术后 6 个月癫痫无发作（Engel ⅠA）的比例为 84%，2 年时为 76%，5 年及以后为 76%，手术 12 年后的纵向结局稳定。多变量分析表明，术后 6 个月的急性术后发作和对侧发作间期棘波与癫痫复发有关。术前能独立行走且脑磁共振成像上无脑桥萎缩的患者术后运动功能恶化的可能性更大。否则，术后的步行能力和手部功能保持不变。在完成神经心理学测试的 19 例患者中，17 例术后结果稳定或改善。
成人半脑切除术是一种安全有效的手术，其无癫痫发作率和功能结局与儿童相似。
