癫痫的半球侧方与垂直离断术：一项系统评价与Meta分析
Lateral versus vertical hemispheric disconnection for epilepsy: a systematic review and meta-analysis.
作者信息
Cossu Massimo, Nichelatti Michele, De Benedictis Alessandro, Rizzi Michele
机构信息
1"Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy.
2Service of Biostatistics, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano, Niguarda, Milan, Italy; and.
出版信息
J Neurosurg. 2021 Oct 15;136(6):1627-1637. doi: 10.3171/2021.5.JNS21949. Print 2022 Jun 1.
OBJECTIVE
Lateral periinsular hemispherotomy (LPH) and vertical parasagittal hemispherotomy (VPH) are the most popular disconnective techniques for intractable epilepsies associated with unilateral hemispheric pathologies. The authors aimed to investigate possible differences in seizure outcome and complication rates between patients who underwent LPH and VPH.
METHODS
A comprehensive literature search of PubMed and Embase identified English-language articles published from database inception to December 2019 that reported series (minimum 12 patients with follow-up ≥ 12 months) on either LPH or VPH. Pooled rates of seizure freedom and complications (with a particular focus on hydrocephalus) were analyzed using meta-analysis to calculate both fixed and random effects. Heterogeneity (Cochran's Q test) and inconsistency (fraction of Q due to actual heterogeneity) were also calculated.
RESULTS
Twenty-five studies were included. Data from 825 patients were available for seizure outcome analysis (583 underwent LPH and 242 underwent VPH), and data from 692 patients were available for complication analysis (453 underwent LPH and 239 underwent VPH). No differences were found in the pooled rates of Engel class I seizure outcome between patients who underwent LPH (80.02% and 79.44% with fixed and random effects, respectively) and VPH (79.89% and 80.69% with fixed and random effects, respectively) (p = 0.953). No differences were observed in the pooled rates of shunted hydrocephalus between patients who underwent LPH (11.34% and 10.63% with fixed and random effects, respectively) and VPH (11.07% and 9.98% with fixed and random effects, respectively) (p = 0.898). Significant heterogeneity and moderate inconsistency were determined for hydrocephalus occurrence in patients who underwent both LPH and VPH.
CONCLUSIONS
LPH and VPH techniques present similar excellent seizure outcomes, with comparable and acceptable safety profiles.
目的
外侧岛周大脑半球切除术（LPH）和垂直矢旁大脑半球切除术（VPH）是治疗与单侧半球病变相关的难治性癫痫最常用的离断技术。作者旨在研究接受LPH和VPH治疗的患者在癫痫发作结果和并发症发生率方面可能存在的差异。
方法
对PubMed和Embase进行全面文献检索，确定从数据库建立至2019年12月发表的英文文章，这些文章报告了关于LPH或VPH的系列研究（至少12例患者，随访时间≥12个月）。使用荟萃分析计算癫痫发作缓解率和并发症（特别关注脑积水）的合并率，以计算固定效应和随机效应。还计算了异质性（ Cochr an Q检验）和不一致性（实际异质性导致的Q的比例）。
结果
纳入25项研究。825例患者的数据可用于癫痫发作结果分析（583例接受LPH，242例接受VPH），692例患者的数据可用于并发症分析（453例接受LPH，239例接受VPH）。接受LPH治疗的患者（固定效应和随机效应分别为80.02%和79.44%）和接受VPH治疗的患者（固定效应和随机效应分别为79.89%和80.69%）在Engel I级癫痫发作结果的合并率方面未发现差异（p = 0.953）。接受LPH治疗的患者（固定效应和随机效应分别为11.34%和10.63%）和接受VPH治疗的患者（固定效应和随机效应分别为11.07%和9.98%）在分流性脑积水的合并率方面未观察到差异（p = 0.898）。对于接受LPH和VPH治疗的患者，脑积水的发生存在显著异质性和中度不一致性。
结论
LPH和VPH技术具有相似的优异癫痫发作结果，安全性相当且可接受。
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