Koszewski W, Czarkwiani L, Bidziński J
Katedra i Klinika Neurochirurgii AM w Warszawie.
Neurol Neurochir Pol. 1998;32 Suppl 2:81-94.
MATERIAL, METHOD: Authors present the results of surgical treatment in a series of 93 patients with medically intractable epilepsy and large epileptogenic foci, in whom multilobar resections have been performed. They constituted 13% of a group of 716 patients subjected to surgery due to drug resistant epilepsy in the period 1957-1996, in the Department of Neurosurgery, Medical University of Warsaw, Poland. Patients treated with multilobar resection constituted the group, characterised by the most severe course of epilepsy, so they usually had a long seizures' history at the time of operation (more than 10 years duration of the disease in 37% of patients), albeit they were qualified to surgery at a relatively young age (mean age at the time of surgery: 16-th year of life). Trauma was the most frequent underlying aetiologic factor (perinatal trauma and other major head injury were documented in 28% and 30% of patients respectively). Morphological abnormalities of the resected brain tissue were found on pathological examination (light microscope) in 68% of patients in this series.
Perioperative mortality was 3%. At a follow-up examination (mean follow-up period 7 years postoperatively): 30% of patients were seizure free, in 13% of patients drug discontinuation was possible. In 23% of patients less than 2-3 seizures per year occurred. So totally in 53% of patients, good result of treatment was achieved (none or only very rare seizures). In 35% of patients surgery failed to control seizures' frequency. 9% of patients were lost from follow-up evaluation.
Multilobar resection (if acceptable from the clinical point of view) may be an effective treatment choice in patients with medically uncontrollable seizures and huge epileptogenic foci. This treatment modality may offer recovery from seizures or significant improvement to 53% of patients treated. The radical removal of epileptogenic foci, age of the patients higher than 18 year of life at the time of operation, focal character of EEG abnormalities and occurrence of only one type of seizures, were found to be good prognostic factors. On the other hand younger age of the patients operated, the presence of generalized slow waves in the interictal EEG recordings and the occurrence of various types of seizures, influenced adversely on the prognosis.
材料与方法：作者介绍了对93例药物治疗难治性癫痫且有大的致痫灶患者进行手术治疗的结果，这些患者均接受了多脑叶切除术。他们占1957年至1996年期间波兰华沙医科大学神经外科因药物难治性癫痫接受手术的716例患者中的13%。接受多脑叶切除术治疗的患者组具有癫痫病程最严重的特点，因此他们在手术时通常有较长的癫痫发作史（37%的患者病程超过10年），尽管他们在相对年轻的时候（手术时平均年龄：16岁）就符合手术条件。创伤是最常见的潜在病因（围产期创伤和其他重大头部损伤分别在28%和30%的患者中记录到）。在该系列中，68%的患者在病理检查（光学显微镜）中发现切除脑组织的形态学异常。
围手术期死亡率为3%。在随访检查（术后平均随访期7年）时：30%的患者无癫痫发作，13%的患者可以停药。23%的患者每年发作少于2 - 3次。因此，总共有53%的患者治疗效果良好（无发作或仅有非常罕见的发作）。35%的患者手术未能控制癫痫发作频率。9%的患者失访。
多脑叶切除术（如果从临床角度可接受）可能是药物无法控制发作且有致痫大病灶患者的有效治疗选择。这种治疗方式可为53%接受治疗的患者带来癫痫发作缓解或显著改善。发现致痫灶的彻底切除、手术时患者年龄大于18岁、脑电图异常的局灶性特征以及仅出现一种类型的癫痫发作是良好的预后因素。另一方面，接受手术患者的年龄较小、发作间期脑电图记录中存在广泛性慢波以及出现多种类型的癫痫发作对预后有不利影响。
