期刊
NEUROSURGERY
卷 91, 期 1, 页码 93-102出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1227/neu.0000000000001958
关键词
Epilepsy surgery; Hemispherectomy; Rasmussen encephalitis; Seizure outcomes
资金
- NIH [R01 NS097719]
This study retrospectively analyzed long-term seizure outcomes and reoperation rates in Rasmussen encephalitis (RE) patients who underwent hemispherectomy. The study found that complete disconnection of the diseased hemisphere had a positive impact on seizure-freedom and reduced the need for reoperations. Shorter preoperative duration of hemiparesis, shorter duration of epilepsy, and preoperative bilateral MRI abnormalities were associated with an increased risk of reoperation.
BACKGROUND: Rasmussen encephalitis (RE) is a rare inflammatory disease affecting one hemisphere, causing progressive neurological deficits and intractable seizures.OBJECTIVE: To report long-term seizure outcomes, reoperations, and functional outcomes in patients with RE who underwent hemispherectomy at our institution.METHODS: Retrospective review was performed for all patients with RE who had surgery between 1998 and 2020. We collected seizure history, postoperative outcomes, and functional data. Imaging was independently reviewed in a blinded fashion by 2 neurosurgeons and a neuroradiologist.RESULTS: We analyzed 30 patients with RE who underwent 35 hemispherectomies (5 reoperations). Using Kaplan-Meier analysis, seizure-freedom rate was 81.5%, 63.6%, and 55.6% at 1, 5, and 10 years after surgery, respectively. Patients with shorter duration of hemiparesis preoperatively were less likely to be seizure-free at follow-up (P = .011) and more likely to undergo reoperation (P = .004). Shorter duration of epilepsy (P = .026) and preoperative bilateral MRI abnormalities (P = .011) were associated with increased risk of reoperation. Complete disconnection of diseased hemisphere on postoperative MRI after the first operation improved seizure-freedom (P = .021) and resulted in fewer reoperations (P = .034), and reoperation resulted in seizure freedom in every case.CONCLUSION: Obtaining complete disconnection is critical for favorable seizure outcomes from hemispherectomy, and neurosurgeons should have a low threshold to reoperate in patients with RE with recurrent seizures. Rapid progression of motor deficits and bilateral MRI abnormalities may indicate a subpopulation of patients with RE with increased risk of needing reoperation. Overall, we believe that hemispherectomy is a curative surgery for the majority of patients with RE, with excellent long-term seizure outcome.
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