癫痫患儿胼胝体全段切开手术的疗效分析

Analysis of the therapeutic efficacy of total corpus callosotomy for children with epilepsy

目的探讨癫痫患儿胼胝体全段切开手术的疗效及安全性。方法选取上海徳济医院癫痫中心2017年6月至2022年8月收治的24例癫痫患儿,所有患儿均接受了胼胝体全段切开手术治疗。收集患儿的临床基线资料,并进行预后评估。结果纳入本研究的患儿年龄2~13岁,平均6.2岁,其中全面性癫痫发作7例,失张力及跌倒发作17例。术后随访5年、平均随访时间2.8年,术后发作频率减少≥50%16例,发作频率减少<50%或加重5例,余3例术后随访数据缺失。术后发作结果以Engel评分进行分级,其中EengelⅠ级7例,EengelⅡ级3例,EengelⅢ级6例,EengelⅣ级5例。术后有13例患儿的智力及生长发育明显进步,主要为术后发作频率减少≥50%的患儿,其中以语言和肢体活动改善多见。24例患儿中,严重并发症为术后出现脑梗死并行去骨瓣减压1例,硬膜下积液并行钻孔引流1例。所有患儿均无颅内感染、术后脑积水及脑出血发生。结论胼胝体全段切开术对全面性发作、失张力发作及跌倒发作的患儿有较好的疗效,较单纯行胼胝体部分切开的患儿有效率高,且并发症发生率无明显增加,术后能够很大程度地促进患儿的生长发育及智力的提高。药物难治性癫痫患儿越早进行手术并发症发生率越低,且手术效果较年龄大的患儿更好。

Objective To explore the efficacy and safety of total corpus callosotomy for children with epilepsy.Methods A total of 24 children with epilepsy were selected from the Epilepsy Center at Shanghai Neuromedical Center from June 2017 to August 2022.All of them underwent total corpus callosotomy.Clinical baseline data of the children was collected and the prognosis was assessed.Results The children included in this study were aged 2~13 years,with an average age of 6.2 years.Among them,there were 7 children with generalized epileptic seizures and 17 children with atonic seizure and falling attack.Postoperative follow-up was conducted for 5 years,with an average follow-up time of 2.8 years.There were 16 children whose frequency of postoperative seizures was decreased by≥50%,5 cases whose frequency was decreased by<50%or worsened.The remaining 3 cases had missing postoperative follow-up data.The postoperative seizure results were graded based on Engel score,including 7 children of Engel grade I,3 children of Engel grade II,6 children of Engel grade III and 5 children of Engel grade IV.After surgery,13 children showed significant improvement in intelligence,growth and development,and most of them were the children with a reduction of≥50%in postoperative seizure frequency.Among them,the improvements in language and physical activity were very common.Among 24 cases,there was 1 child with severe complications,who had postoperative cerebral infarction and underwent decompressive craniectomy,and 1 child who had subdural fluid accumulation and underwent drilling drainage.All child had no occurrence of intracranial infection,hydrocephalus and cerebral hemorrhage after surgery.Conclusion Total corpus callosotomy has a good effect on children with generalized seizures,atonic seizures and fall attacks.Its efficiency is higher than that of partial corpus callosotomy alone.The incidence of complications is not significantly increased.Postoperatively,it can greatly promote the growth and development of children and improve their intelligence.The earlier the surgery for children with epilepsy,the lower the incidence of complications,and the better the surgical effect than that of older children.