Ye Vincent C, Shah Ashish H, Sur Samir, Achua Justin K, Wang Shelly, Ibrahim George M, Bhatia Sanjiv, Ragheb John
1Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Ontario, Canada.
2Department of Neurosurgery, University of Miami; and.
J Neurosurg Pediatr. 2020 Apr 24;26(2):157-164. doi: 10.3171/2020.1.PEDS19537. Print 2020 Aug 1.
Uncontrolled epilepsy is associated with serious deleterious effects on the neurological development of infants and has been described as "catastrophic epilepsy." Recently, there has been increased emphasis on early surgical interventions to preserve or rescue neurodevelopmental outcomes in infants with early intractable epilepsy. The enthusiasm for early treatments is often tempered by concerns regarding the morbidity of neurosurgical procedures in very young patients. Here, the authors report outcomes following the surgical management of infants (younger than 1 year).
The authors performed a retrospective review of patients younger than 1 year of age who underwent surgery for epilepsy at Miami (Nicklaus) Children's Hospital and Jackson Memorial Hospital between 1994 and 2018. Patient demographics, including the type of interventions, were recorded. Seizure outcomes (at last follow-up and at 1 year postoperatively) as well as complications are reported.
Thirty-eight infants (median age 5.9 months) underwent a spectrum of surgical interventions, including hemispherectomy (n = 17), focal resection (n = 13), and multilobe resections (n = 8), with a mean follow-up duration of 9.1 years. Hemimegalencephaly and cortical dysplasia were the most commonly encountered pathologies. Surgery for catastrophic epilepsy resulted in complete resolution of seizures in 68% (n = 26) of patients, and 76% (n = 29) had a greater than 90% reduction in seizure frequency. Overall mortality and morbidity were 0% and 10%, respectively. The latter included infections (n = 2), infarct (n = 1), and immediate reoperation for seizures (n = 1).
Surgical intervention for catastrophic epilepsy in infants remains safe, efficacious, and durable. The authors' work provides the longest follow-up of such a series on infants to date and compares favorably with previously published series.
未得到控制的癫痫对婴儿的神经发育具有严重的有害影响，被描述为“灾难性癫痫”。最近，人们越来越强调早期手术干预，以保护或挽救患有早期难治性癫痫婴儿的神经发育结局。然而，对于非常年幼患者神经外科手术的发病率的担忧，往往会削弱人们对早期治疗的热情。在此，作者报告了1岁以下婴儿手术治疗的结果。
作者对1994年至2018年间在迈阿密（尼克劳斯）儿童医院和杰克逊纪念医院接受癫痫手术的1岁以下患者进行了回顾性研究。记录了患者的人口统计学信息，包括干预类型。报告了癫痫发作结局（最后一次随访时和术后1年）以及并发症情况。
38名婴儿（中位年龄5.9个月）接受了一系列手术干预，包括大脑半球切除术（n = 17）、局灶性切除术（n = 13）和多叶切除术（n = 8），平均随访时间为9.1年。半侧巨脑回和皮质发育异常是最常见的病理情况。灾难性癫痫手术使68%（n = 26）的患者癫痫发作完全缓解，76%（n = 29）的患者癫痫发作频率降低超过90%。总体死亡率和发病率分别为0%和10%。后者包括感染（n = 2）、梗死（n = 1）和因癫痫发作立即再次手术（n = 1）。
婴儿灾难性癫痫的手术干预仍然是安全、有效和持久的。作者的研究提供了迄今为止此类婴儿系列最长时间的随访，与先前发表的系列相比具有优势。
