Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Epilepsia. 2022 Nov;63(11):2782-2801. doi: 10.1111/epi.17381. Epub 2022 Sep 3.
Surgery can cure or significantly improve both the frequency and the intensity of seizures in patients with medication-refractory epilepsy. The set of diagnostic and therapeutic interventions involved in the path from initial consultation to definitive surgery is complex and includes a multidisciplinary team of neurologists, neurosurgeons, neuroradiologists, and neuropsychologists, supported by a very large epilepsy-dedicated clinical architecture. In recent years, new practices and technologies have emerged that dramatically expand the scope of interventions performed. Stereoelectroencephalography has become widely adopted for seizure localization; stereotactic laser ablation has enabled more focal, less invasive, and less destructive interventions; and new brain stimulation devices have unlocked treatment of eloquent foci and multifocal onset etiologies. This article articulates and illustrates the full framework for how epilepsy patients are considered for surgical intervention, with particular attention given to stereotactic approaches.
手术可以治愈或显著改善药物难治性癫痫患者的发作频率和强度。从初步咨询到最终手术，涉及的一系列诊断和治疗干预措施非常复杂，包括神经科医生、神经外科医生、神经放射科医生和神经心理学家组成的多学科团队，由一个非常大的癫痫专科临床架构提供支持。近年来，出现了许多新的实践和技术，极大地扩展了可进行的干预范围。立体脑电图已广泛用于癫痫灶定位；立体定向激光消融术使干预更加局限、微创和低损伤；新型脑刺激设备则为语言功能区和多灶性起源病因的治疗提供了可能。本文详细阐述并说明了癫痫患者接受手术干预的整个框架，特别关注了立体定向方法。
