Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Department of Neurosurgery, Texas Children's Hospital, Houston, TX, USA.
Adv Tech Stand Neurosurg. 2024;49:291-306. doi: 10.1007/978-3-031-42398-7_13.
Pediatric epilepsy has a worldwide prevalence of approximately 1% (Berg et al., Handb Clin Neurol 111:391-398, 2013) and is associated with not only lower quality of life but also long-term deficits in executive function, significant psychosocial stressors, poor cognitive outcomes, and developmental delays (Schraegle and Titus, Epilepsy Behav 62:20-26, 2016; Puka and Smith, Epilepsia 56:873-881, 2015). With approximately one-third of patients resistant to medical control, surgical intervention can offer a cure or palliation to decrease the disease burden and improve neurological development. Despite its potential, epilepsy surgery is drastically underutilized. Even today only 1% of the millions of epilepsy patients are referred annually for neurosurgical evaluation, and the average delay between diagnosis of Drug Resistant Epilepsy (DRE) and surgical intervention is approximately 20 years in adults and 5 years in children (Solli et al., Epilepsia 61:1352-1364, 2020). It is still estimated that only one-third of surgical candidates undergo operative intervention (Pestana Knight et al., Epilepsia 56:375, 2015). In contrast to the stable to declining rates of adult epilepsy surgery (Englot et al., Neurology 78:1200-1206, 2012; Neligan et al., Epilepsia 54:e62-e65, 2013), rates of pediatric surgery are rising (Pestana Knight et al., Epilepsia 56:375, 2015). Innovations in surgical approaches to epilepsy not only minimize potential complications but also expand the definition of a surgical candidate. In this chapter, three alternatives to classical resection are presented. First, laser ablation provides a minimally invasive approach to focal lesions. Next, both central and peripheral nervous system stimulation can interrupt seizure networks without creating permanent lesions. Lastly, focused ultrasound is discussed as a potential new avenue not only for ablation but also modulation of small, deep foci within seizure networks. A better understanding of the potential surgical options can guide patients and providers to explore all treatment avenues.
儿科癫痫的全球患病率约为 1%（Berg 等人，《Handb Clin Neurol》111:391-398, 2013），不仅与生活质量下降有关，还与执行功能长期缺陷、显著的社会心理压力、认知结局不良和发育迟缓有关（Schraegle 和 Titus，《Epilepsy Behav》62:20-26, 2016；Puka 和 Smith，《Epilepsia》56:873-881, 2015）。大约三分之一的患者对药物治疗无反应，手术干预可以提供治愈或缓解，以减轻疾病负担并改善神经发育。尽管有其潜力，但癫痫手术的利用率却极低。即使在今天，每年也只有数百万癫痫患者中的 1%被转介接受神经外科评估，而药物难治性癫痫（Drug Resistant Epilepsy，DRE）诊断与手术干预之间的平均延迟时间在成人中约为 20 年，在儿童中约为 5 年（Solli 等人，《Epilepsia》61:1352-1364, 2020）。据估计，只有三分之一的手术候选者接受了手术干预（Pestana Knight 等人，《Epilepsia》56:375, 2015）。与成人癫痫手术率稳定下降（Englot 等人，《Neurology》78:1200-1206, 2012；Neligan 等人，《Epilepsia》54:e62-e65, 2013）形成鲜明对比的是，儿科手术率正在上升（Pestana Knight 等人，《Epilepsia》56:375, 2015）。癫痫手术方法的创新不仅最大限度地减少了潜在的并发症，而且还扩大了手术候选者的定义。在本章中，介绍了三种替代经典切除术的方法。首先，激光消融提供了一种针对局灶性病变的微创方法。其次，中枢和周围神经系统刺激都可以在不产生永久性病变的情况下阻断癫痫网络。最后，讨论了聚焦超声作为一种潜在的新途径，不仅可用于消融，还可用于调节癫痫网络内的小而深的病灶。更好地了解潜在的手术选择可以指导患者和提供者探索所有治疗途径。
