Baumgartner Christoph, Koren Johannes P, Britto-Arias Martha, Zoche Lea, Pirker Susanne
Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.
Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.
F1000Res. 2019 Oct 29;8. doi: 10.12688/f1000research.17714.1. eCollection 2019.
With a prevalence of 0.8 to 1.2%, epilepsy represents one of the most frequent chronic neurological disorders; 30 to 40% of patients suffer from drug-resistant epilepsy (that is, seizures cannot be controlled adequately with antiepileptic drugs). Epilepsy surgery represents a valuable treatment option for 10 to 50% of these patients. Epilepsy surgery aims to control seizures by resection of the epileptogenic tissue while avoiding neuropsychological and other neurological deficits by sparing essential brain areas. The most common histopathological findings in epilepsy surgery specimens are hippocampal sclerosis in adults and focal cortical dysplasia in children. Whereas presurgical evaluations and surgeries in patients with mesial temporal sclerosis and benign tumors recently decreased in most centers, non-lesional patients, patients requiring intracranial recordings, and neocortical resections increased. Recent developments in neurophysiological techniques (high-density electroencephalography [EEG], magnetoencephalography, electrical and magnetic source imaging, EEG-functional magnetic resonance imaging [EEG-fMRI], and recording of pathological high-frequency oscillations), structural magnetic resonance imaging (MRI) (ultra-high-field imaging at 7 Tesla, novel imaging acquisition protocols, and advanced image analysis [post-processing] techniques), functional imaging (positron emission tomography and single-photon emission computed tomography co-registered to MRI), and fMRI significantly improved non-invasive presurgical evaluation and have opened the option of epilepsy surgery to patients previously not considered surgical candidates. Technical improvements of resective surgery techniques facilitate successful and safe operations in highly delicate brain areas like the perisylvian area in operculoinsular epilepsy. Novel less-invasive surgical techniques include stereotactic radiosurgery, MR-guided laser interstitial thermal therapy, and stereotactic intracerebral EEG-guided radiofrequency thermocoagulation.
癫痫的患病率为0.8%至1.2%，是最常见的慢性神经系统疾病之一；30%至40%的患者患有药物难治性癫痫（即抗癫痫药物无法充分控制癫痫发作）。癫痫手术是其中10%至50%患者的一种有价值的治疗选择。癫痫手术旨在通过切除致痫组织来控制癫痫发作，同时通过保留重要脑区避免神经心理和其他神经功能缺损。癫痫手术标本中最常见的组织病理学发现是成人的海马硬化和儿童的局灶性皮质发育不良。尽管大多数中心近期内侧颞叶硬化和良性肿瘤患者的术前评估及手术有所减少，但非病灶性患者、需要颅内记录的患者以及新皮质切除术患者有所增加。神经生理学技术（高密度脑电图[EEG]、脑磁图、电和磁源成像、EEG功能磁共振成像[EEG-fMRI]以及病理性高频振荡记录）、结构磁共振成像（MRI）（7特斯拉超高场成像、新型成像采集协议以及先进图像分析[后处理]技术）、功能成像（正电子发射断层扫描和单光子发射计算机断层扫描与MRI联合登记）以及fMRI的最新进展显著改善了非侵入性术前评估，并为以前未被视为手术候选者的患者开辟了癫痫手术的选择。切除性手术技术的技术改进有助于在如岛盖部癫痫的岛周区等高度精细的脑区成功且安全地进行手术。新型微创外科技术包括立体定向放射外科、磁共振引导激光间质热疗以及立体定向脑内EEG引导射频热凝术。
