Combined operations for the treatment of intractable epilepsy

Objective Several surgical methods were applied in combination after sufficiently and strictly assessing some of the patients with intractable epilepsy beforehand and the clinical efficacies of the combined operations were evaluated.Methods Twenty-five of the 116 cases with intractable epilepsy,who had been treated within 13 months in the department of neurosurgery of East Hospital, Tongji University,were performed on by combined operations.As for the 25 cases,seizure types included generalized tonic-clonic seizures,complex partial seizures and absentia,and among the 25 cases,14 had two of the above seizure types.The 25 cases were all administered with multiple antiepileptic drugs in total before operations,especially during the later stage of the disease course,when 2 to 3 antiepileptic drugs were given to them simultaneously.All the 25 cases received preoperative 24 h electroencephalography (EEG) monitoring and cerebral magnetic resonance imaging (MRI) scan,among which 19 had preoperative subdural and depth electrode investigation and 1 had brain positron emission tomography (PET) scan.The operations were performed with the monitoring of cortex EEG and depth electrodes.A total of 13 cases were treated with resection of the anterior temporal lobe,hippocampus and amygdale+multiple subpial transection (MST) in some regions of the frontal part,assisted with the craniotomy of the frontotemporal lobe,among which 7 also underwent anterior corpus callosotomy;11 cases received resection of softening lesions in the frontal part+motor area MST,assisted with the craniotomy of the frontal part,among which 2 also underwent anterior corpus callosotomy;1 case was performed on with resection of shrunk cortex in the left occipital lobe+posterior corpus callosotomy+ right parieto-occipital MST,assisted with the craniotomy of bilateral parieto-occipital regions.Results No postoperative death or serious complications occurred.Less antiepileptic drugs were given to the 25 cases after operations:23 cases took only one kind of epileptic drugs and the other two cases received two kinds.The 6-to 12-month follow-up study indicated that the surgical efficacy of 17 cases was the level of Engel 1,of 4 cases was the level of Engel 2 and of the other 4 cases was the level of Engel 3. Statistical results showed that efficacies of the patients younger than 40 were better than those above 40 (P0.05) and efficacies of the patients with the course of epilepsy less than 10 years were better than those with the course of epilepsy above 10 years (P0.05).There were no differences between those who had or did not have evident structural abnormality by cerebral MRI examinations (P0.05),Conclusion With the premise of strict preoperative assessment,especially of the comprehensive analyses by the neurosurgeons who are proficient at neurological electrophysiology,the combined operations are very effective for the treatment of intractable epilepsy.