Behrens E, Schramm J, Zentner J, König R
Department of Neurosurgery, University of Bonn, Germany.
Neurosurgery. 1997 Jul;41(1):1-9; discussion 9-10. doi: 10.1097/00006123-199707000-00004.
There are few modern data on the complications of surgery for epilepsy from the neurosurgeon's point of view. A survey of complications observed in a large current epilepsy surgery series is presented to facilitate the assessment of a risk:benefit ratio, which must be known when planning for epilepsy surgery and counseling patients.
A series of 429 consecutive patients operated on during 6.5 years in the newly established University of Bonn epilepsy surgery program was, in part, retrospectively, and, in larger part, prospectively analyzed for complications originating from 279 invasive diagnostic procedures and 429 therapeutic procedures. Neuropsychological and psychiatric complications as well as the rate of failure to control seizures are not addressed in this article.
Two hundred and seventy-nine temporal operations, 59 frontal operations, 22 other extratemporal operations, 33 callosotomies, 3 multilobectomies, and 33 hemispherectomies were performed. Complications were grouped into general surgical and neurological complications. No mortality resulted from 708 invasive procedures. Two hundred and seventy-nine invasive diagnostic procedures (various combinations of strip, grid, and depth electrode insertions) resulted in 3.6% transient morbidity (2.9% surgical complications, 0.7% neurological complications) and 0.7% permanent morbidity (dysphasia). During 429 therapeutic procedures, 33 surgical complications were encountered. None of these resulted in permanent morbidity, except for the necessity for permanent shunt insertion in three patients. Wound infection was the most frequent surgical complication, but we were able to demonstrate a steady decrease during the 6.5-year observation period. The total rate of neurological complications in 429 therapeutic procedures was 5.4%, with 3.03% causing transient morbidity and 2.33% causing permanent morbidity.
Our data indicate that epilepsy surgery can be performed with an acceptable rate of resultant morbidity. The indications for epilepsy surgery, the learning curve determined, and the results from other series are discussed in the light of these figures.
从神经外科医生的角度来看，关于癫痫手术并发症的现代数据较少。本文呈现了对当前一个大型癫痫手术系列中观察到的并发症的调查，以促进对风险效益比的评估，而在规划癫痫手术和为患者提供咨询时必须了解这一比例。
对新成立的波恩大学癫痫手术项目在6.5年期间连续进行手术的429例患者进行了分析，部分为回顾性分析，大部分为前瞻性分析，涉及279例侵入性诊断程序和429例治疗程序引发的并发症。本文未涉及神经心理学和精神方面的并发症以及癫痫发作控制失败率。
共进行了279例颞叶手术、59例额叶手术、22例其他颞外手术、33例胼胝体切开术、3例多叶切除术和33例大脑半球切除术。并发症分为普通外科并发症和神经科并发症。708例侵入性手术未导致死亡。279例侵入性诊断程序（条状、栅格状和深部电极插入的各种组合）导致3.6%的短暂性发病（2.9%为外科并发症，0.7%为神经科并发症）和0.7%的永久性发病（言语障碍）。在429例治疗程序中，出现了33例外科并发症。除3例患者需要永久性置入分流管外，这些并发症均未导致永久性发病。伤口感染是最常见的外科并发症，但我们发现在6.5年的观察期内其发生率稳步下降。429例治疗程序中神经科并发症的总发生率为5.4%，其中3.03%导致短暂性发病，2.33%导致永久性发病。
我们的数据表明，癫痫手术的发病率在可接受范围内。根据这些数据，对癫痫手术的适应症、确定的学习曲线以及其他系列的结果进行了讨论。
