Which is the Most Appropriate Disconnection Surgery for Refractory Epilepsy in Childhood?

DOI Web Site PubMed 参考文献26件
  • KISHIMA Haruhiko
    Department of Neurosurgery, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital
  • OSHINO Satoru
    Department of Neurosurgery, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital
  • TANI Naoki
    Department of Neurosurgery, Osaka University Graduate School of Medicine
  • MARUO Yomoyuki
    Department of Neurosurgery, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital
  • MORRIS Shayne
    Department of Neurosurgery, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital
  • KHOO Hui Ming
    Department of Neurosurgery, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital
  • YANAGISAWA Takufumi
    Department of Neurosurgery, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital
  • SHIMONO Kuriko
    Department of Pediatrics, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital
  • OKINAGA Takeshi
    Department of Pediatrics, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital
  • HIRATA Masayuki
    Department of Neurosurgery, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital
  • KATO Amami
    Department of Neurosurgery, Kinki University School of Medicine
  • YOSHIMINE Toshiki
    Department of Neurosurgery, Osaka University Graduate School of Medicine Epilepsy Center, Osaka University Hospital

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Children with unilobar or multilobar pathology issuing in refractory epilepsy are potential candidates for surgical treatment. Extensive surgery results in good seizure control, but it also increases the risk of neurological deficits as well as motor and mental problems. We reviewed the cases of 19 children with refractory epilepsy treated surgically at Osaka University Hospital. Four of the 19 patients underwent temporal disconnection, 2 underwent occipital lobectomy, 4 underwent temporoparietooccipital disconnection, 6 underwent functional hemispherotomy, and 3 underwent corpus callosotomy. A good surgical outcome, i.e., Engel’s class I or II, was achieved in 12 (63%) of the 19 patients. Excellent surgical outcomes and satisfactory motor and mental development were achieved in 4 patients who underwent temporoparietooccipital disconnection. The outcomes of functional hemispherectomy were also satisfactory. The outcomes of temporal disconnection and corpus callosotomy were poor in comparison to outcomes of the other procedures. We believe that better surgical outcomes would have been achieved with temporoparietooccipital disconnection in some cases treated by temporal disconnection or occipital resection. Adequate extensive surgical procedures should be considered for refractory childhood epilepsy arising from unilobar or multilobar pathology.

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