Department of Functional Neurosurgery, Hospices Civils de Lyon and University of Lyon, Lyon, France, Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, and University of Lyon, Lyon, France.
Epileptic Disord. 2021 Apr 1;23(2):347-356. doi: 10.1684/epd.2021.1275.
In patients with intractable partial epilepsy who are eligible for epilepsy surgery, the best seizure control requires complete resection of the epileptogenic zone. When the epileptogenic zone is located very near to, or even with the eloquent cortex, this can be a challenge. In this study, we investigated the efficacy of awake craniotomy techniques to completely resect these epileptic zones while preserving the neural functions. We conducted a retrospective cohort study of 17 consecutive patients with intractable partial seizures of different aetiologies (non-lesional epilepsy [n=3], tuberous sclerosis [n=1], hypoxic ischaemic insult [n=1], dysembryoplastic neuroepithelial tumours [DNET] [n=2], focal cortical dysplasia type 2 [FCD] [n=4], and other malformations of cortical development [n=6]), located in eloquent language cortex (frontal [n=7], insular [n=5], and latero-temporal [n=5] regions). All patients were operated on between 2010 and 2019 for resective epilepsy surgery under awake conditions, with the aid of direct cortical stimulation. This report aimed to study the feasibility, efficacy and limitations of using the awake craniotomy technique for surgical resections of epileptogenic zones involving eloquent language cortex. Postoperative epilepsy control and neurological function were assessed and followed. The mean follow-up period was 5.7 years. In one patient, the surgery was aborted before resection. In the other patients, Engel Class I was achieved in seven patients (43.75%) and Engel Class II in four patients (25%), and worthwhile improvement (Engel Class I and II) was achieved in 11 patients (68.75%). Postoperative neurological deficits were encountered in four patients (23.5%). However, all these deficits were regressive and were absent at the last follow-up visit. Using the awake craniotomy technique, seizure freedom can be achieved in a high proportion of patients with epileptogenic zones located in language areas, who were previously considered only candidates for palliative measures.
在适合癫痫手术的难治性部分性癫痫患者中,最佳的癫痫控制需要完全切除致痫区。当致痫区位于或靠近功能区(例如运动区、语言区)时,这是一个挑战。本研究旨在调查在保留神经功能的情况下,使用清醒开颅技术完全切除这些癫痫灶的疗效。
我们对 17 例不同病因(非病变性癫痫[3 例]、结节性硬化症[1 例]、缺氧缺血性损伤[1 例]、发育不良性神经上皮肿瘤[DNET][2 例]、2 型局灶性皮质发育不良[FCD][4 例]和其他皮质发育不良[6 例])的难治性部分性癫痫患者进行了回顾性队列研究,这些患者的致痫区位于功能区(额区[7 例]、岛叶[5 例]和颞叶[5 例])。所有患者均于 2010 年至 2019 年在清醒状态下接受了有助于直接皮质刺激的致痫灶切除术。本报告旨在研究使用清醒开颅技术切除涉及语言功能区的致痫灶的可行性、疗效和局限性。术后癫痫控制和神经功能进行了评估和随访。平均随访时间为 5.7 年。在 1 例患者中,手术在切除前被中止。在其余患者中,7 例(43.75%)患者达到了 Engel Ⅰ级,4 例(25%)患者达到了 Engel Ⅱ级,11 例(68.75%)患者有显著改善(达到 Engel Ⅰ级和Ⅱ级)。4 例(23.5%)患者出现术后神经功能缺损,但所有缺损均为进行性,并在最后一次随访时消失。使用清醒开颅技术,可以使相当一部分致痫区位于语言区的患者获得癫痫无发作,这些患者以前被认为只能采取姑息性治疗。