BACKGROUND Although multilobar resections correspond to one-fifth of pediatric epilepsy surgery, there are little data on long-term seizure control. OBJECTIVE To investigate the long-term seizure outcomes of children and adolescents undergoing multilobar epilepsy surgery and identify their predictors. METHODS In this retrospective study, we considered 69 consecutive patients that underwent multilobar epilepsy surgery at the age of 10.0 ± 5.0 yr (mean ± SD). The magnetic resonance imaging revealed a lesion in all but 2 cases. Resections were temporo-parieto(-occipital) in 30%, temporo-occipital in 41%, parieto-occipital in 16%, and fronto-(temporo)-parietal in 13% cases. Etiologies were determined as focal cortical dysplasia in 67%, perinatal or postnatal ischemic lesions in 23%, and benign tumors in 10% of cases. RESULTS At last follow-up of median 9 yr (range 2.8-14.8), 48% patients were seizure free; 33% were off antiepileptic drugs. 10% of patients, all with dysplastic etiology, required reoperations: 4 of 7 achieved seizure freedom. Seizure recurrence occurred mostly (80%) within the first 6 mo. Among presurgical variables, only an epileptogenic zone far from eloquent cortex independently correlated with significantly higher rates of seizure arrest in multivariate analysis. Among postsurgical variables, the absence of residual lesion and of acute postsurgical seizures was independently associated with significantly higher rates of seizure freedom. CONCLUSION Our study demonstrates that multilobar epilepsy surgery is effective regarding long-term seizure freedom and antiepileptic drug withdrawal in selected pediatric candidates. Epileptogenic zones-and lesions-localized distant from eloquent cortex and, thus, fully resectable predispose for seizure control. Acute postsurgical seizures are critical markers of seizure recurrence that should lead to prompt reevaluation.

中文翻译：

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儿童和青少年多叶癫痫手术：长期癫痫发作自由的预测因素

背景 虽然多叶切除术相当于小儿癫痫手术的五分之一，但关于长期癫痫发作控制的数据很少。目的 调查儿童和青少年接受多叶癫痫手术的长期癫痫结果并确定其预测因素。方法 在这项回顾性研究中，我们考虑了 69 名在 10.0 ± 5.0 岁（平均值 ± SD）时接受多叶癫痫手术的连续患者。磁共振成像显示，除 2 例外，其他所有病例均有病变。30% 的颞顶（-枕）切除，41% 的颞-枕，16% 的顶-枕和 13% 的额-（颞）-顶。67% 的病因被确定为局灶性皮质发育不良，23% 的围产期或产后缺血性病变，以及 10% 的良性肿瘤。结果 在中位 9 年（范围 2.8-14.8）的最后一次随访中，48% 的患者没有癫痫发作；33% 的人停用抗癫痫药物。10% 的患者（全部为发育不良病因）需要再次手术：7 名患者中有 4 名实现无癫痫发作。癫痫复发主要 (80%) 发生在前 6 个月内。在术前变量中，只有远离雄辩皮质的致癫痫区与多变量分析中显着较高的癫痫发作率独立相关。在术后变量中，没有残留病灶和没有急性术后癫痫发作与显着较高的无癫痫发作率独立相关。结论 我们的研究表明，多叶癫痫手术对于选定的儿科候选者的长期无癫痫发作和抗癫痫药物停药是有效的。致癫痫区和病变位于远离雄辩皮质的地方，因此，完全可切除的易于控制癫痫发作。急性术后癫痫发作是癫痫发作复发的关键标志，应立即重新评估。