Preoperative assessment and surgical strategy of intractable epilepsy: report of 125 cases_Journal of Epilepsy

Authors：

 WANG Huanming , HU Fei , CHEN Jun , XIONG Yubo , YANG Yanping

Department of Neurosurgery, Wuhan Brain Hospital & Changhang General Hospital, Wuhan 430010, China;

Corresponding?author：

WANG Huanming, Email: 1808381741@qq.com

Keywords：

Intractable epilepsy; Preoperative assessment; Surgery

DOI：

10.7507/2096-0247.20180064

Video：

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ObjectivesTo explore the preoperative assessment method, operative approach and post-operative effect of intractable epilepsy.MethodsOne hundred and twenty five intractable epilepsy patients (85 males and 40 females) from Wuhan Brain Hospital during June 2009 to June 2017 were collected in this study. Their age ranged from 1 to 70 years old, with disease course of 1 ~ 32 years. All the patients underwent VEEG monitoring and MRI examination before operation, and MRS was performed when necessary. Some patients also received psychological assessment. According to the result of VEEG and MRI results, all the patients underwent operations under ECoG monitoring . The surgery effect was followed-up for more than 1 year.ResultsThe post-operative follow-up showed that satisfactory result was achieved in 50 cases, remarkable improvement in 29 cases, good effect in 23 cases, bad effect in 19 cases, and no improvement in 4 cases. The total effective rate of epilepsy surgery was 81.6%, and excellent rate was 41.6%. The effective rate was 81.3% in 80 cases of epileptogenic focus epileptic lesion resection, 87.5% in 40 cases of anterior temporal lobectomy (ATL), and 100% in 3 cases of functional hemispherectomy was, and good effect in the cases of pure cortical coagulation and VNS.ConclusionsThe surgical effects of ATL, epileptogenic focus resection and functional hemispherectomy are better than that of pure corpus callosotomy, multiple subpial transaction (MST), multiple subdural transversely fibrinectomy, VNS or cortical coagulation. So epileptogenic focus should be accurately located preoperatively, and it is better to choose resection operation in order to increase the surgical effect of intractable epilepsy.

Citation： WANG Huanming, HU Fei, CHEN Jun, XIONG Yubo, YANG Yanping. Preoperative assessment and surgical strategy of intractable epilepsy: report of 125 cases. Journal of Epilepsy, 2018, 4(5): 391-395. doi: 10.7507/2096-0247.20180064 Copy

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1. 中華醫學會編著臨床診療指南 (癲癇病分冊). 北京: 人民衛生出版社: 2015: 57-58.
2. 譚啟富. 癲癇外科的治療現狀. 中華神經外科雜志, 1999, 15(6): 331-332.
3. 譚啟富. 我國癲癇外科發展之管見. 中國臨床神經外科雜志, 2006, 11(8): 449.
4. 譚啟富, 胡志剛. 再論癲癇手術療效評價問題. 中國現代神經疾病雜志, 2009, 9(4): 323-326.
5. Nowell M, Miserocchi A, McEvoy AW, et al. Advances in epilepsy surgery. J Neurol Neurosurg Psychiatry, 2014, 85(11): 1273-1279.
6. Engel L. Surgical treatment of the epilepsies. 2nd Edition. New York: Raven Press, 1993: 23-25.
7. Spencer SS, Spencer DD. Surgery for epilepsy. Boston. Blackwell Scientific, 1991: 50-55.
8. Wyler AR, Wilkus AT, Rostad SW, et al. Multiple subpial transection for partial seizures in sensorimotor cortex. Neurosurgery, 1995, 37(6): 112-118.
9. Smith MC. Multiple subpial transection in patients with extratemporal epilepsy. Epilepsia, 1998, 39(Suppl 4): 81-89.
10. Hufnagel A, Zentuer T, Fernandez G, et al. Multiple subpial transection for control of epileptic seizures: effectiveness and safety. Epilepsia, 1997, 38(6): 678-683.
11. 欒國明, 李云林, 閆麗, 等. 癇灶切除輔助性腦皮層橫行纖維熱灼治療功能區癲癇的臨床研究. 中華神經外科雜志, 2002, 18(4): 209-212.
12. Wheless JW, Gienapp AJ, Ryvlin P. Vagus nerve stimulation (VNS) therapy update. Epilepsy Behav, 2018: pii: S1525-5050.
13. 田宏, 凌至培, 常鵬飛, 等. 胼胝體切開聯合皮層熱灼術治療難治性癲癇. 立體定向和功能性神經外科雜志, 2007, 20(4): 193-195.
14. 王煥明, 胡飛, 陳俊, 等. 迷走神經刺激手術治療頑固性癲癇. 癲癇雜志, 2017, 3(5): 452-454.

Journal of Epilepsy

Preoperative assessment and surgical strategy of intractable epilepsy: report of 125 cases

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