儿童创伤后癫痫的半球切开术
Hemispherotomy for Pediatric Post-Traumatic Epilepsy.
摘要(中文译文)
大脑半球切开术是治疗特定类型耐药性半球性癫痫的有效方法，包括围产期卒中、Rasmussen脑炎和Sturge-Weber综合征。据报道，创伤后癫痫（PTE）发生于约10%的创伤性脑损伤（TBI）患儿中。TBI作为大脑半球切开术的适应证尚未得到广泛评估，因为其影响很少为单侧性。本文报告了5例因耐药性半球性PTE而接受大脑半球切开术的儿科病例结果。对2018年至2022年间在费城儿童医院接受大脑半球切开术的所有TBI继发耐药性PTE的儿科患者（n=5）进行了回顾性分析。所有患者最初因TBI接受了去骨瓣减压术及随后的颅骨修补术；在随后几年中符合大脑半球切开术的标准，从而在癫痫外科会议上建议行大脑半球切开术。回顾了临床特征、癫痫发作及功能结局以及术后并发症。癫痫发作结局根据Engel标准进行分类。5例耐药性PTE患儿（中位年龄：8.3岁，范围：5.0-10.3岁）接受了经外侧裂大脑半球切开术。TBI病因包括非意外创伤（n=3）和机动车事故（n=2）。所有患者均达到Engel Ia级癫痫发作结局（中位随访：15个月，范围：5-39个月），抗癫痫药物从中位数术前5种减少至术后1种。无患者经历再次手术。神经心理学结局因患者而异，大多数表现为术后获益与挑战并存。我们展示了使用大脑半球切开术治疗5例儿童耐药性半球性PTE的情况，癫痫发作频率显著减少，神经心理学结局为混合性或改善。
Abstract
Hemispherotomy is an effective treatment for select forms of drug-resistant hemispheric epilepsy, including perinatal stroke, Rasmussen's encephalitis, and Sturge-Weber syndrome. Post-traumatic epilepsy (PTE) has been reported to occur in ~10% of children following traumatic brain injury (TBI). TBI has not been extensively evaluated as an indication for hemispherotomy, as its effects are rarely unilateral. Here, we report the results from five pediatric cases of hemispherotomy for drug-resistant hemispheric PTE. A retrospective review was performed of all pediatric patients with drug-resistant PTE secondary to TBI who underwent hemispherotomy between 2018 and 2022 at the Children's Hospital of Philadelphia ( = 5). All patients initially underwent craniectomy and subsequent cranioplasty due to TBI; criteria for hemispherotomy were met in the following years, leading to a recommendation for hemispherotomy at the epilepsy surgery conference. Clinical characteristics, seizure and functional outcomes, and postoperative complications were reviewed. Seizure outcomes were classified according to the Engel criteria. Five children (median age: 8.3 years, range: 5.0-10.3 years) with drug-resistant PTE underwent lateral trans-sylvian hemispherotomy. TBI etiology included non-accidental trauma ( = 3) and motor vehicle accidents ( = 2). All patients exhibited Engel Class Ia seizure outcomes (median follow-up: 15 months, range: 5-39 months), with a reduction in anti-seizure medications from a median of five preoperatively to one postoperatively. No patient experienced re-operation. Neuropsychological outcomes were patient-specific, with most exhibiting a mix of gains and challenges after surgery. We demonstrate the use of hemispherotomy to treat drug-resistant, hemispheric PTE in five children, with excellent reduction in seizure frequency and mixed or improved neuropsychological outcomes.
如何引用
AMA
Habib E Akouri, Samuel B Tomlinson, Kevin Wojcik, Nankee K Kumar, Kathleen Galligan, Sudha K Kessler, et al. Hemispherotomy for Pediatric Post-Traumatic Epilepsy.. Brain sciences. 2026; doi:10.3390/brainsci16060657.
APA
Habib E Akouri, Samuel B Tomlinson, Kevin Wojcik, Nankee K Kumar, Kathleen Galligan, Sudha K Kessler, et al (2026). Hemispherotomy for Pediatric Post-Traumatic Epilepsy.. Brain sciences. https://doi.org/10.3390/brainsci16060657
GB/T 7714
Habib E Akouri, Samuel B Tomlinson, Kevin Wojcik, Nankee K Kumar, Kathleen Galligan, Sudha K Kessler, et al. Hemispherotomy for Pediatric Post-Traumatic Epilepsy.[J]. Brain sciences, 2026 doi:10.3390/brainsci16060657.
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