Cossu Massimo, d'Orio Piergiorgio, Barba Carmen, Asioli Sofia, Cardinale Francesco, Casciato Sara, Caulo Massimo, Colicchio Gabriella, Consales Alessandro, D'Aniello Alfredo, De Benedictis Alessandro, De Palma Luca, Didato Giuseppe, Di Gennaro Giancarlo, Di Giacomo Roberta, Esposito Vincenzo, Guerrini Renzo, Nichelatti Michele, Revay Martina, Rizzi Michele, Vatti Giampaolo, Villani Flavio, Zamponi Nelia, Tassi Laura, Marras Carlo Efisio
"C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.
Institute of Neuroscience, National Research Council, Parma, Italy.
Neurosurgery. 2021 Jan 13;88(2):384-393. doi: 10.1093/neuros/nyaa369.
Hippocampal sclerosis (HS) may be associated with focal cortical dysplasia IIIa (FCD IIIa) in patients undergoing surgery for temporal lobe epilepsy (TLE).
To investigate whether the anatomo-electro-clinical profile and surgical outcome in patients with HS-related TLE are affected by coexisting FCD IIIa.
A total of 220 patients, operated in 5 centers, with at least 24 mo follow-up (FU), were retrospectively studied. Preliminary univariate and subsequent multivariate analyses were performed to investigate possible associations between several potential presurgical, surgical, and postsurgical predictors and different variables (Engel's class I and Engel's class Ia, co-occurrence of FCD IIIa).
At last available postoperative control (FU: range 24-95 mo, median 47 mo), 182 (82.7%) patients were classified as Engel's class I and 142 (64.5%) as Engel's class Ia. At multivariate analysis, extension of neocortical resection and postoperative electroencephalogram were significantly associated with Engel's class I, whereas length of FU had a significant impact on class Ia in the whole cohort and in isolated HS (iHS) patients, but not in the FCD IIIa group. No differences emerged in the anatomo-electro-clinical profile and surgical results between patients with FCD IIIa and with iHS.
Coexistence of FCD IIIa did not confer a distinct anatomo-electro-clinical profile to patients with HS-related epilepsy. Postoperative seizure outcome was similar in FCD IIIa and iHS cases. These findings indicate limited clinical relevance of FCD IIIa in HS-related epilepsy and might be useful for refining future FCD classifications. Further studies are needed to clarify the correlation of class Ia outcome with the duration of FU.
在接受颞叶癫痫（TLE）手术的患者中，海马硬化（HS）可能与IIIa型局灶性皮质发育不良（FCD IIIa）相关。
探讨共存的FCD IIIa是否会影响HS相关TLE患者的解剖 - 电 - 临床特征及手术效果。
回顾性研究了在5个中心接受手术且至少有24个月随访（FU）的220例患者。进行了初步单因素分析及随后的多因素分析，以研究术前、术中和术后的几个潜在预测因素与不同变量（恩格尔I级和恩格尔Ia级、FCD IIIa的共存情况）之间的可能关联。
在最后一次可获得的术后检查时（FU：范围24 - 95个月，中位数47个月），182例（82.7%）患者被分类为恩格尔I级，142例（64.5%）为恩格尔Ia级。多因素分析显示，新皮质切除范围和术后脑电图与恩格尔I级显著相关，而随访时间对整个队列及孤立性HS（iHS）患者的Ia级有显著影响，但对FCD IIIa组无影响。FCD IIIa患者和iHS患者在解剖 - 电 - 临床特征及手术结果方面未发现差异。
FCD IIIa的共存并未使HS相关癫痫患者具有独特的解剖 - 电 - 临床特征。FCD IIIa和iHS病例的术后癫痫发作结果相似。这些发现表明FCD IIIa在HS相关癫痫中的临床相关性有限，可能有助于完善未来的FCD分类。需要进一步研究以阐明Ia级结果与随访时间的相关性。
