微创破坏性,消融性和分离性癫痫手术

IF 0.2 Q4 PEDIATRICS
J. Treiber, James C. Bayley, D. Curry
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引用次数: 0

摘要

通过显微外科解剖进行的常规癫痫手术通常需要使用高速钻头和长切口创建大的颅骨工作窗口。在过去的几十年里,微创技术的发展具有更小的切口、相当的疗效、更短的住院时间和更好的安全性。这些微创替代方法利用立体定向、超声、放射治疗和内窥镜技术。虽然不能完全取代传统手术治疗癫痫的所有病因,这些微创技术已经彻底改变了现代癫痫手术,并已成为神经外科医生曲目的宝贵资产。内窥镜允许外科医生在使用锁孔或微型开颅术进行切除和分离性癫痫手术时有足够的可视化。现代立体定向技术,如激光间质热疗法和射频消融,可以作为内侧颞叶癫痫的可行替代方案,并且可以破坏病变组织的深层区域,而不会引起显微外科手术相关的并发症,如下丘脑错构瘤。这些立体定向技术在治疗失败的情况下不排除未来的手术,并且在常规手术失败后成功使用。多个消融通道可在一次手术中完成,可用于大目标的病变或简化多灶性癫痫的治疗。这些立体定向技术甚至已成功地用于分离手术,如半球切开术和胼胝体切开术。对于无法忍受手术的患者,立体定向放射手术是一种微创选择,可以在最小的手术风险下改善癫痫控制。微创神经外科的进展为耐药癫痫提供了可行的治疗选择,恢复更快,对功能脑的损伤更小,对于那些可能不选择传统手术的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Minimally Invasive Destructive, Ablative, and Disconnective Epilepsy Surgery
Abstract Conventional epilepsy surgery performed by microsurgical dissection typically requires large cranial working windows created with high-speed drills and lengthy incisions. In the past few decades, minimally invasive techniques have been developed with smaller incisions, comparable efficacy, shorter hospitalizations, and better safety profiles. These minimally invasive alternatives utilize stereotactic, ultrasonic, radiotherapeutic, and endoscopic techniques. Although not able to completely replace conventional surgery for all etiologies of epilepsy, these minimally invasive techniques have revolutionized modern epilepsy surgery and have been an invaluable asset to the neurosurgeon's repertoire. The endoscope has allowed for surgeons to have adequate visualization during resective and disconnective epilepsy surgeries using keyhole or miniature craniotomies. Modern stereotactic techniques such as laser interstitial thermal therapy and radiofrequency ablation can be used as viable alternatives for mesial temporal lobe epilepsy and can destroy lesional tissue deep areas without the approach-related morbidity of microsurgery such as with hypothalamic hamartomas. These stereotactic techniques do not preclude future surgery in the settings of treatment failure and have been used successfully after failed conventional surgery. Multiple ablation corridors can be performed in a single procedure that can be used for lesioning of large targets or to simplify treating multifocal epilepsies. These stereotactic techniques have even been used successfully to perform disconnective procedures such as hemispherotomies and corpus callosotomies. In patients unable to tolerate surgery, stereotactic radiosurgery is a minimally invasive option that can result in improved seizure control with minimal procedural risks. Advances in minimally invasive neurosurgery provide viable treatment options for drug-resistant epilepsy with quicker recovery, less injury to functional brain, and for patients that may otherwise not choose conventional surgery.
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来源期刊
自引率
0.00%
发文量
21
期刊介绍: The Journal of Pediatric Epilepsy is an English multidisciplinary peer-reviewed international journal publishing articles on all topics related to epilepsy and seizure disorders, epilepsy surgery, neurology, neurosurgery, and neuropsychology in childhood. These topics include the basic sciences related to the condition itself, the differential diagnosis, natural history, and epidemiology of seizures, and the investigation and practical management of epilepsy (including drug treatment, neurosurgery and non-medical and behavioral treatments). Use of model organisms and in vitro techniques relevant to epilepsy are also acceptable. Journal of Pediatric Epilepsy provides an in-depth update on new subjects and current comprehensive coverage of the latest techniques used in the diagnosis and treatment of childhood epilepsy.
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