Department of Neurological Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, 19131, USA.
Division of Neurosurgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Childs Nerv Syst. 2021 Jul;37(7):2153-2161. doi: 10.1007/s00381-021-05176-x. Epub 2021 Apr 27.
Several variations of functional disconnection surgery have been described for the treatment of lateralized, hemispheric, drug-resistant epilepsy in children. The purpose of this study is to investigate the existing literature regarding patient selection, approach, and outcomes after hemispherotomy.
A systematic review of the English literature through February 2019 was performed in accordance with the PRISMA statement. The articles were classified by level of evidence and summarized in an evidentiary table. Seizure outcomes, functional outcomes, surgical techniques, complications, and patient selection were critically analyzed.
A total of 173 papers were reviewed, of which 37 met criteria of inclusion and exclusion. Thirteen studies were classified as level III evidence, the remaining reached level IV. Vertical and lateral hemispherotomy achieve similar rates of seizure freedom and functional outcomes, though parasagittal and interhemispheric approaches may have shorter operative times and less blood loss. Etiology, bilateral MRI abnormalities, and nonlateralizing EEG did not predict worse seizure or functional outcomes.
Both vertical and lateral hemispherotomy approaches result in durable, reproducible benefits to epilepsy severity and functional status in appropriately selected pediatric patients.
功能性离断术已有多种改良术式用于治疗儿童侧化、偏侧性、药物难治性癫痫。本研究旨在调查关于半脑切除术的患者选择、手术入路和结局的现有文献。
按照 PRISMA 声明对 2019 年 2 月前的英文文献进行系统性回顾。根据证据水平对文章进行分类，并在证据表中进行总结。对手术结果、功能结果、手术技术、并发症和患者选择进行批判性分析。
共回顾了 173 篇论文，其中 37 篇符合纳入和排除标准。13 项研究被归类为 III 级证据，其余的达到了 IV 级。垂直和水平半脑切除术在实现无癫痫发作和功能结果方面具有相似的疗效，但旁矢状和半球间入路可能具有更短的手术时间和更少的出血量。病因、双侧 MRI 异常和非偏侧性 EEG 并不能预测更差的癫痫发作或功能结局。
垂直和水平半脑切除术在适当选择的儿科患者中均能持久、可重复地改善癫痫严重程度和功能状态。
