Huang Jun, Chen Liang, Cao Xi, Gao An-Liang
Department of Neurosurgery, The Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, Chengdu 610057, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2023 Mar;54(2):406-410. doi: 10.12182/20230360107.
To analyze the residual post-resection electrocorticography (ECoG) status and the related risk factors in patients with medically intractable epilepsy (MIE).
A retrospective analysis was conducted to cover 146 MIE patients who underwent craniotomy for surgical resection in the department of Neurosurgery, Second Affiliated Hospital of Chengdu Medical College between January 2006 and January 2018. The patients were divided into a non-residual group ( =54) and a residual group ( =92) according to their ECoG results after the first resection surgery. Then, the 92 patients in the residual group underwent additional palliative surgery and they were further divided into an improvement subgroup ( =50) and a non-improvement subgroup ( =42), according to the reevaluation results of improvements in their postoperative ECoG. The differences in the mean annual seizure-free rate among the groups were compared. Univariate and multivariate logistic regression analysis was conducted to analyze the risk factors of residual post-resection ECoG.
During the ten-year follow-up after the operation, the mean annual seizure-free rate was 86.7% in the non-residual group and 57.1% in the residual group, showing significant difference between the two groups ( <0.001). In the subgroups, the mean annual seizure-free rate was 71% in the improvement subgroup and 46.5% in the non-improved subgroup, showing significant difference between the two subgroups ( =0.003). Logistic regression showed that risk factors associated with residual post-resection ECoG included being female, patient age at the time of surgery being over 18, multi-lobe epilepsy, functional area involvement, and negative MRI findings ( <0.05). Analysis of the subgroups showed that multi-lobe epilepsy and functional area involvement were risk factors related to not showing improvements in post-resection ECoG ( <0.05).
Findings based on the status of residual post-resection ECoG have shown that patients without residual post-resection ECoG had the best treatment outcomes, and patients who had residual post-resection ECoG, but showed significant improvement after palliative surgery had the second best treatment outcomes. Patients who were female, who had their surgeries when they were older than 18, and who had multi-lobe epilepsy, functional area involvement, or negative MRI results were more likely to have residual post-resection ECoG. Among patients with residual post-resection ECoG, those with multi-lobe epilepsy and functional area involvement showed little improvement in residual post-resection ECoG even after undergoing additional palliative surgery.
分析药物难治性癫痫（MIE）患者术后残留皮质脑电图（ECoG）状态及相关危险因素。
对2006年1月至2018年1月在成都医学院第二附属医院神经外科接受开颅手术切除的146例MIE患者进行回顾性分析。根据首次切除手术后的ECoG结果，将患者分为无残留组（=54）和残留组（=92）。然后，残留组的92例患者接受了额外的姑息性手术，并根据术后ECoG改善的重新评估结果进一步分为改善亚组（=50）和未改善亚组（=42）。比较各组间平均无癫痫发作率的差异。进行单因素和多因素logistic回归分析，以分析切除术后残留ECoG的危险因素。
术后十年随访期间，无残留组平均年无癫痫发作率为86.7%，残留组为57.1%，两组间差异有统计学意义（<0.001）。在亚组中，改善亚组平均年无癫痫发作率为71%，未改善亚组为46.5%，两组间差异有统计学意义（=0.003）。logistic回归显示，与切除术后残留ECoG相关的危险因素包括女性、手术时年龄超过18岁、多叶癫痫、功能区受累以及MRI结果为阴性（<0.05）。亚组分析显示，多叶癫痫和功能区受累是与切除术后ECoG无改善相关的危险因素（<0.05）。
基于切除术后残留ECoG状态的研究结果表明，切除术后无残留ECoG的患者治疗效果最佳，切除术后有残留ECoG但姑息性手术后有显著改善的患者治疗效果次之。女性、手术时年龄大于18岁、患有多叶癫痫、功能区受累或MRI结果为阴性的患者更有可能出现切除术后残留ECoG。在切除术后残留ECoG的患者中，患有多叶癫痫和功能区受累的患者即使接受了额外的姑息性手术，其切除术后残留ECoG的改善也很小。
