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立体定向脑电图对不同侧别前颞叶切除术长期预后的影响:一项单中心回顾性研究

The Effect of Stereoelectroencephalography on the Long-Term Outcomes of Different Side Anterior Temporal Lobectomy: A Single-Center Retrospective Study.

作者信息

Zhang Bo, Wang Xiongfei, Wang Jing, Wang Mengyang, Guan Yuguang, Liu Zhao, Zhang Yao, Zhao Meng, Ding Haoran, Xu Ke, Deng Jiahui, Li Tianfu, Luan Guoming, Zhou Jian

机构信息

Department of Neurosurgery, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China.

Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China.

出版信息

World Neurosurg. 2024 Nov;191:e831-e837. doi: 10.1016/j.wneu.2024.09.054. Epub 2024 Sep 13.

DOI:10.1016/j.wneu.2024.09.054
PMID:39278540
Abstract

PURPOSE

Anterior temporal lobectomy (ATL) is the most common surgical treatment for temporal lobe epilepsy (TLE), and Stereoelectroencephalography (SEEG) plays a critical role in precisely localizing the epileptogenic zone (EZ). This study aimed to explore the effect of SEEG on the long-term outcomes of different side ATL.

METHODS

From March 2012 to February 2020, a retrospective analysis was conducted on 231 TLE patients who underwent standard ATL surgery. According to the surgical sides and the utilization of SEEG during preoperative evaluation, the patients were categorized into 4 groups, with a follow-up period exceeding 2 years.

RESULTS

Among the 231 TLE patients, the probability of being seizure-free 2 years after the surgery was 80.52%, which decreased to 65.65% after 5 years. There was no significant difference in outcomes between SEEG and non-SEEG patients. For overall and non-SEEG patients, there was no significant difference in short-term outcomes between different surgical sides. However, the long-term outcomes of right ATL patients were significantly better than left. Interestingly, for patients who underwent SEEG, there was no significant difference in both short-term and long-term outcomes between different surgical sides.

CONCLUSIONS

Some TLE patients encounter challenges in localizing the EZ through noninvasive evaluation, necessitating the use of SEEG for precise localization. Furthermore, their seizure outcomes after surgery can be the same with the patients who have a clear EZ in noninvasive evaluation. And SEEG patients can achieve a more stable long-term prognosis than non-SEEG patients.

摘要

目的

前颞叶切除术(ATL)是颞叶癫痫(TLE)最常见的外科治疗方法,立体定向脑电图(SEEG)在精确确定癫痫灶(EZ)方面起着关键作用。本研究旨在探讨SEEG对不同侧ATL长期疗效的影响。

方法

对2012年3月至2020年2月期间接受标准ATL手术的231例TLE患者进行回顾性分析。根据手术侧别和术前评估时SEEG的使用情况,将患者分为4组,随访时间超过2年。

结果

在231例TLE患者中,术后2年无癫痫发作的概率为80.52%,5年后降至65.65%。SEEG组和非SEEG组患者的疗效无显著差异。对于总体患者和非SEEG患者,不同手术侧别的短期疗效无显著差异。然而,右侧ATL患者的长期疗效明显优于左侧。有趣的是,对于接受SEEG的患者,不同手术侧别的短期和长期疗效均无显著差异。

结论

一些TLE患者通过无创评估定位EZ存在困难,需要使用SEEG进行精确的定位。此外,他们术后的癫痫发作结果与无创评估中EZ明确的患者相同。并且SEEG患者比非SEEG患者能获得更稳定的长期预后。

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