ABSTRACT

Objective: Management of patients after failed epilepsy surgery is still challenging. Advanced diagnostic and intraoperative tools including magneto-encephalography (MEG) as well as neuronavigation and intraoperative magnetic resonance imaging (iopMRI) may contribute to a better postoperative seizure outcome in this patient group.

Methods: We retrospectively analyzed consecutive patients after reoperation of failed epilepsy surgery for medically refractory epilepsy at the University of Erlangen between 1988 and 2017. Inclusion criteria for patients were available MEG, neuronavigation and iopMRI data. The Engel scale was used to categorize seizure outcome.

Results: We report on 27 consecutive patients (13 female/14 male mean age at first surgery 29.4 years) who had operative revision of the first resection after failed epilepsy surgery. An improved seizure outcome postoperatively was observed in 78% of patients (p < 0.001) with 55% seizure free (Engel I) patients after a mean follow-up time of 4.9 years. In detail, 80% of lesional cases were seizure free compared to 59% of MRI negative patients. Localizing MEG spike activity in the vicinity of the first resection cavity was present in 12 of 27 patients (44%) corresponding to 83% (10/12) of MEG localizing spike patients having advanced seizure outcome after operative revision.

Conclusion: Re-operation after failed surgery in refractory epilepsy may lead to a better seizure outcome in the majority of patients. Preoperative MEG may support the decision for surgery and may facilitate targeting epileptogenic tissue for re-resection by employing navigation and iopMR imaging.

摘要

目的：癫痫手术失败后患者的管理仍然具有挑战性。先进的诊断和术中工具，包括脑磁图 (MEG) 以及神经导航和术中磁共振成像 (iopMRI)，可能有助于该患者组获得更好的术后癫痫发作结果。

方法：我们回顾性分析了 1988 年至 2017 年在埃尔兰根大学进行的药物难治性癫痫手术失败再手术后的连续患者。患者的纳入标准是可获得的 MEG、神经导航和 iopMRI 数据。使用恩格尔量表对癫痫发作结果进行分类。

结果：我们报告了 27 名连续患者（首次手术时 13 名女性/14 名男性的平均年龄为 29.4 岁），他们在癫痫手术失败后进行了第一次切除的手术翻修。在平均 4.9 年的随访时间后，78% 的患者（p < 0.001）和 55% 的无癫痫发作（Engel I）患者术后癫痫发作结果有所改善。具体而言，80% 的病变病例无癫痫发作，而 MRI 阴性患者为 59%。27 名患者中有 12 名 (44%) 存在第一个切除腔附近的局部 MEG 棘突活动，相当于手术翻修后具有晚期癫痫发作结果的 MEG 局部棘突患者的 83% (10/12)。

结论：在难治性癫痫手术失败后再次手术可能会导致大多数患者更好的癫痫发作结果。术前 MEG 可以支持手术决定，并可以通过使用导航和 iopMR 成像促进靶向致癫痫组织进行再次切除。