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首页> 外文期刊>Current treatment options in neurology >Surgical Treatment for Extratemporal Epilepsy.
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Surgical Treatment for Extratemporal Epilepsy.

机译：颞外癫痫的外科治疗。

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Partial seizures of extratemporal origin may present unique challenges in the patient with medically refractory seizures. The efficacy of an extratemporal focal cortical resection may be less effective than an anterior temporal lobectomy for intractable epilepsy. The potential operative complications may be increased in individuals with extratemporal epilepsy because of functional cerebral cortex involvement and the need for a large cortical resection to significantly reduce seizure tendency. Partial seizures of extratemporal origin are predominantly associated with frontal lobe epilepsy. The most effective treatment for intractable partial epilepsy is a focal cortical resection with excision of the epileptogenic zone, that is, an area of ictal onset and initial seizure propagation. The preoperative evaluation and operative strategy in patients with partial epilepsy of extratemporal origin associated with pharmacoresistant seizures is determined by the anatomic localization of the epileptogenic zone and the presence of a substrate-directed disorder. The goals of surgical treatment in extratemporal epilepsy include rendering the patient seizure-free, avoiding operative morbidity, and allowing the individual to become a participating and productive member of society. Before surgical treatment, the individual with extratemporal epilepsy will require a comprehensive preoperative evaluation, including routine electroencephalogram (EEG), long-term EEG monitoring, neuropsychologic studies, and magnetic resonance imaging (MRI). Patients with a normal MRI study, conflicting preoperative evaluation, or involvement of suspected functional cerebral cortex would require chronic intracranial EEG monitoring. The rationale for intracranial EEG includes localization of the ictal onset zone or intraoperative functional mapping, or both. Two-fluorodeoxyglucose positron emission tomography studies are usually unremarkable in patients with extratemporal epilepsy and normal MRI scans. Subtraction ictal single photon emission computed tomography coregistered to MRI (SISCOM) study may be useful to demonstrate a localized cerebral perfusion alteration in patients with intractable partial epilepsy. The diagnostic yield of SISCOM has been confirmed in patients with extratemporal epilepsy undergoing surgical treatment. The results of the SISCOM study may tailor the placement of intracranial EEG electrodes and affect the operative strategy. Patients with extratemporal epilepsy overall are less favorable operative candidates than individuals with medial temporal lobe epilepsy. However, individuals with MRI-identified lesional pathology of SISCOM-identified perfusion alterations concordant with the epileptogenic zone may be considered for surgical treatment. Chronic intracranial EEG monitoring may be necessary to confirm the localization of the ictal onset zone before epilepsy surgery. Patients with normal neuroimaging studies and extratemporal epilepsy are unlikely to be rendered seizure-free with focal cortical resection and should be considered candidates for other alternative forms of treatment for intractable partial epilepsy. Patients with non-substrate-directed extratemporal epilepsy should undergo a preoperative evaluation and surgical treatment at a comprehensive epilepsy center with extensive experience in chronic intracranial EEG monitoring and contemporary neuroimaging procedures because of the inherently high acuity associated with the operative management clinical disorder.
机译：颞外起源的部分癫痫发作可能对难治性癫痫发作的患者提出独特的挑战。对于顽固性癫痫，颞前局灶性皮质切除术的疗效可能不如前颞叶切除术。由于功能性大脑皮层受累以及需要大面积切除皮质以显着降低癫痫发作趋势，患有颞外癫痫患者的潜在手术并发症可能会增加。颞外起源的部分发作主要与额叶癫痫有关。对于顽固性部分性癫痫，最有效的治疗方法是切除皮层，切除癫痫发生区，即发作发作和最初发作的区域。伴有耐药性癫痫发作的颞外部分癫痫患者的术前评估和手术策略取决于癫痫发生区的解剖学定位和底物定向疾病的存在。颞外癫痫手术治疗的目标包括使患者免于癫痫发作，避免手术发病以及使个人成为社会参与和生产性成员。在进行手术治疗之前，患有颞前癫痫的患者需要进行全面的术前评估，包括常规脑电图（EEG），长期脑电图监测，神经心理学研究和磁共振成像（MRI）。 MRI检查正常，术前评估相抵触或涉嫌功能性大脑皮层受累的患者将需要进行慢性颅内EEG监测。颅内EEG的基本原理包括发作期区域的定位或术中功能图谱，或两者兼而有之。在颞外癫痫和MRI扫描正常的患者中，二氟脱氧葡萄糖正电子发射断层显像研究通常并不明显。与MRI（SISCOM）共同注册的减法性单眼光子发射计算机断层扫描可能有助于证实顽固性部分性癫痫患者的局部脑灌注改变。 SISCOM的诊断率已在接受手术治疗的颞外癫痫患者中得到证实。 SISCOM研究的结果可能会调整颅内EEG电极的位置并影响手术策略。总体而言，颞外癫痫患者不如内侧颞叶癫痫患者更适合手术。但是，可以考虑将具有MRI识别的SISCOM识别的，与癫痫发生区一致的灌注改变的病变病理的个体用于手术治疗。癫痫手术前可能需要进行慢性颅内EEG监测以确认发作发作区的定位。经过正常的神经影像学检查和颞外癫痫的患者不太可能通过局灶性皮质切除术消除癫痫发作，因此应被视为治疗顽固性部分性癫痫的其他替代疗法的候选人。对于非底物定向的颞前癫痫患者，由于与手术管理临床疾病相关的固有高敏锐度，应在全面的癫痫中心进行术前评估和外科治疗，该中心在慢性颅内脑电图监测和当代神经影像学程序方面具有丰富的经验。

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