Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Neurol India. 2020 Mar-Apr;68(2):270-273. doi: 10.4103/0028-3886.284358.
The posterior quadratic epilepsy (PQE) is a form of a multilobar epilepsy, involving the temporal-parietal and occipital lobes. Basically, epilepsies with localized networks to the posterior temporal, posterior parietal, and occipital lobes can benefit from this type of surgery. Gliosis due to perinatal insult and cortical dysplasis and angiomas in Sturge Weber syndrome involving the PQ have often been cited in the literature as the etiology for PQE. However, before considering surgery, it is important to localize the epileptogenic focus through a complete pre operative work up involving; EEG (Electro-Encephalo-Graphy), video EEG, single photon emission computed tomography (SPECT), positron emission tomography (PET), and magneto encephalography (MEG). Historically, these pathologies were dealt with multi-lobar resections, which were associated with high morbidity and mortality, owing to blood loss, especially in young children, hydrocephalus, and hemosiderosis. Based on the theory of networks involved in epileptogenesis, the concept of disconnection in epilepsy surgery was introduced. Delalande and colleagues, described the technique of hemispheric disconnection (functional hemispherectomy) for pathologies like: hemimegalencephaly, rasmussens encephalitis involving the entire hemisphere. The technique has evolved with time, moving towards minimally invasive endoscopic vertical hemispherotomy, described by Chandra and colleagues. The posterior quadrant disconnection (PQD) evolved as a tailored disconnection on similar lines as hemispherotomy, for managing refractory epilepsy arising from the posterior quadrant. The technique and principles involved in the PQD surgery are similar to the those of peri-insular hemispherotomy and has been described in the literature by few authors. The technique of performing PQD will be described here in a step-wise fashion with illustrations supplemented by a surgical video.
后部象限癫痫（PQE）是多脑叶癫痫的一种形式，涉及颞顶叶和枕叶。基本上，局限于后部颞叶、后部顶叶和枕叶的癫痫发作可以从这种类型的手术中获益。围产期损伤、皮质发育不良和 Sturge-Weber 综合征中的血管畸形导致的神经胶质增生，在文献中常被认为是 PQE 的病因。然而，在考虑手术之前，通过包括脑电图（EEG）、视频 EEG、单光子发射计算机断层扫描（SPECT）、正电子发射断层扫描（PET）和脑磁图（MEG）在内的全面术前评估来定位致痫灶是很重要的。从历史上看，这些病变通过多脑叶切除术来处理，由于失血，尤其是在年幼的儿童中，脑积水和含铁血黄素沉着症，导致发病率和死亡率很高。基于涉及癫痫发作的网络理论，癫痫外科中的断开连接的概念被引入。Delalande 及其同事描述了用于涉及整个半球的偏瘫性巨脑畸形、Rasmussen 脑炎等疾病的半球断开连接（功能性半球切除术）技术。随着时间的推移，该技术不断发展，朝着微创内镜垂直半球切开术发展，由 Chandra 及其同事描述。后部象限断开连接（PQD）作为一种类似半球切开术的定制断开连接方式而发展，用于治疗起源于后部象限的难治性癫痫。PQD 手术涉及的技术和原则与岛周半球切开术相似，已有少数作者在文献中描述过。我们将以分步的方式描述执行 PQD 的技术，并通过手术视频补充说明。
