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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2. 谭启富. 癫痫外科的治疗现状. 中华神经外科杂志, 1999, 15(6): 331-332.
3. 谭启富. 我国癫痫外科发展之管见. 中国临床神经外科杂志, 2006, 11(8): 449.
4. 谭启富, 胡志刚. 再论癫痫手术疗效评价问题. 中国现代神经疾病杂志, 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. 栾国明, 李云林, 闫丽, 等. 痫灶切除辅助性脑皮层横行纤维热灼治疗功能区癫痫的临床研究. 中华神经外科杂志, 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, 常鹏飞, 等. 胼胝体切开联合皮层热灼术治疗难治性癫痫. 立体定向和功能性神经外科杂志, 2007, 20(4): 193-195.
14. 王焕明, 胡飞, 陈俊, 等. 迷走神经刺激手术治疗顽固性癫痫. 癫痫杂志, 2017, 3(5): 452-454.

Journal of Epilepsy

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

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