Shlobin Nathan A, Wang Andrew, Phillips H Westley, Yan Han, Ibrahim George M, Elkaim Lior M, Wang Shuang, Liu Xiaoyan, Cai Lixin, Nguyen Dang K, Fallah Aria, Weil Alexander G
1Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
2Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California.
J Neurosurg Pediatr. 2022 Aug 5;30(4):410-427. doi: 10.3171/2022.6.PEDS22160. Print 2022 Oct 1.
The prevalence of long-term postoperative sensorimotor deficits in children undergoing perirolandic resective epilepsy surgery is unclear. The risk of developing these deficits must be weighed against the potential reduction in seizure frequency after surgery. In this study, the authors investigated the prevalence of sensorimotor deficits after resective surgery at ≥ 1 year postoperatively.
A systematic review and individual patient data meta-analysis was conducted using PubMed, Embase, and Scopus databases. Subgroups of patients were identified and categorized according to their outcomes as follows: group A patients were denoted as seizure free with no postoperative sensorimotor deficits; group B patients experienced seizure recurrence with no deficit; group C patients were seizure free with deficits; and group D patients were not seizure free and with deficits. Rates of sensory deficits were examined in patients undergoing postcentral gyrus resection, and rates of motor deficits were aggregated in patients undergoing precentral gyrus resection.
Of 797 articles resulting from the database searches, 6 articles including 164 pediatric patients at a mean age of 7.7 ± 5.2 years with resection for drug-resistant perirolandic epilepsy were included in the study. Seizure freedom was observed in 118 (72.9%) patients at a mean follow-up of 3.4 ± 1.8 years. In total, 109 (66.5%) patients did not develop sensorimotor deficits at last follow-up, while 55 (33.5%) had permanent deficits. Ten (14.3%) of 70 patients with postcentral gyrus resection had permanent sensory deficits. Of the postcentral gyrus resection patients, 41 (58.6%) patients were included in group A, 19 (27.1%) in group B, 7 (10.0%) in group C, and 3 (4.3%) in group D. Forty (37.7%) of 106 patients with precentral resections had permanent motor deficits. Of the precentral gyrus resection patients, 50 (47.2%) patients were in group A, 16 (15.1%) in group B, 24 (22.6%) in group C, and 16 (15.1%) in group D. Patients without focal cortical dysplasia were more likely to have permanent motor deficits relative to those with focal cortical dysplasia in the precentral surgery cohort (p = 0.02).
In total, 58.6% of patients were seizure free without deficit, 27.1% were not seizure free and without deficit, 10.0% were seizure free but with deficit, and 4.3% were not seizure free and with deficit. Future studies with functional and quality-of-life data, particularly for patients who experience seizure recurrence with no deficits (as in group B in the present study) and those who are seizure free with deficits (as in group C) after treatment, are necessary to guide surgical decision-making.
接受中央旁回切除性癫痫手术的儿童术后长期感觉运动功能障碍的发生率尚不清楚。必须权衡出现这些功能障碍的风险与手术后癫痫发作频率可能降低的情况。在本研究中，作者调查了切除性手术后≥1年时感觉运动功能障碍的发生率。
使用PubMed、Embase和Scopus数据库进行系统评价和个体患者数据荟萃分析。根据患者的结局将其亚组识别并分类如下：A组患者表示无癫痫发作且无术后感觉运动功能障碍；B组患者癫痫复发但无功能障碍；C组患者无癫痫发作但有功能障碍；D组患者有癫痫发作且有功能障碍。对接受中央后回切除术的患者的感觉功能障碍发生率进行检查，并汇总接受中央前回切除术的患者的运动功能障碍发生率。
在数据库检索得到的797篇文章中，本研究纳入了6篇文章，共164例儿科患者，平均年龄7.7±5.2岁，因药物难治性中央旁回癫痫接受手术。平均随访3.4±1.8年时，118例（72.9%）患者实现无癫痫发作。在最后一次随访时，共有109例（66.5%）患者未出现感觉运动功能障碍，而55例（33.5%）有永久性功能障碍。70例接受中央后回切除术的患者中有10例（14.3%）有永久性感觉功能障碍。在接受中央后回切除术的患者中，41例（58.6%）患者属于A组，19例（27.1%）属于B组，7例（10.0%）属于C组，3例（4.3%）属于D组。106例接受中央前回切除术的患者中有40例（37.7%）有永久性运动功能障碍。在接受中央前回切除术的患者中，50例（47.2%）患者属于A组，16例（15.1%）属于B组，24例（22.6%）属于C组，16例（15.1%）属于D组。在中央前回手术队列中，无局灶性皮质发育异常的患者比有局灶性皮质发育异常的患者更有可能出现永久性运动功能障碍（p = 0.02）。
总体而言，58.6%的患者无癫痫发作且无功能障碍，27.1%的患者有癫痫发作但无功能障碍，10.0%的患者无癫痫发作但有功能障碍，4.3% 的患者有癫痫发作且有功能障碍。未来有必要开展关于功能和生活质量数据的研究，特别是针对治疗后癫痫复发但无功能障碍的患者（如本研究中的B组）以及无癫痫发作但有功能障碍的患者（如本研究中的C组），以指导手术决策。
Zotero 插件