[1]薛爽,王睿健,张万增,等.微创手术和神经调控手术治疗药物难治性癫痫的进展[J].中国临床神经外科杂志,2024,29(08):503-507512.[doi:10.13798/j.issn.1009-153X.2024.08.014]
　XUE Shuang,WANG Rui-jian,ZHANG Wan-zeng,et al.Progress of minimally invasive surgery and neuromodulation for drug-resistant epilepsy[J].,2024,29(08):503-507512.[doi:10.13798/j.issn.1009-153X.2024.08.014]
点击复制

微创手术和神经调控手术治疗药物难治性癫痫的进展()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年08期
页码:
503-507512
栏目:
综述
出版日期:
2024-08-30

文章信息/Info

Title:
Progress of minimally invasive surgery and neuromodulation for drug-resistant epilepsy
文章编号:
1009-153X（2024）08-0503-05
作者:
薛爽; 王睿健; 张万增; 张淑知
053000河北，衡水市人民医院神经外科（薛爽、王睿健、张万增、张淑知）
Author(s):
XUE Shuang;  WANG Rui-jian;  ZHANG Wan-zeng;  ZHANG Shu-zhi
Department of Neurosurgery, Hengshui People's Hospital, Hengshui 053000, China
关键词:
药物难治性癫痫; 微创手术; 神经调控技术
Keywords:
Drug-resistant epilepsy;  Minimally invasive surgery;  Neuromodulation
分类号:
R 742.1; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2024.08.014
文献标志码:
A
摘要:
癫痫是常见的神经系统疾病之一，约1/3的癫痫发作无法用药物控制，称为药物难治性癫痫（DRE），可以选择手术治疗。由于各种原因，目前只有一小部分DRE病人接受手术治疗。随着微创手术和神经调控技术的进展，DRE的手术治疗效果明显改善。DRE的微创手术包括激光间质热疗、射频热凝消融、立体定向放射外科，神经调控方法包括迷走神经刺激、脑深部电刺激和反应性神经刺激系统。本文就这些技术治疗DRE的进展进行综述。
Abstract:
Epilepsy is one of the common neurological disorders. Approximately one-third of epileptic seizures cannot be controlled by drugs and are referred to as drug-resistant epilepsy (DRE), for which surgical treatment can be selected. Due to various reasons, currently only a small proportion of DRE patients undergo surgical treatment. With the progress of minimally invasive surgery and neuromodulation technology, the surgical treatment effect of DRE has improved significantly. The minimally invasive surgeries for DRE include laser interstitial thermal therapy, radiofrequency thermocoagulation ablation, and stereotactic radiosurgery. The neuromodulation methods include vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation systems. This article reviews the progress of these techniques in the treatment of DRE.

参考文献/References:

[1]ADAMCZYK B, WEGRZYN K, WILCZYNSKI T, et al. The most common lesions detected by neuroimaging as causes of epilepsy[J]. Medicina (Kaunas), 2021, 57(3): 294-306.
[2]FIANI B, JARRAH R, DOAN T, et al. Stereoelectroencephalography versus subdural electrode implantation to determine whether patients with drug-resistant epilepsy are candidates for epilepsy surgery[J]. Neurol Med Chir (Tokyo), 2021, 61(6): 347-355.
[3]YAMAMOTO T. Recent advancement of technologies and the transition to new concepts in epilepsy surgery[J]. Neurol Med Chir (Tokyo), 2020, 60(12): 581-593.
[4]SOLLI E, COLWELL NA, SAY I, et al. Deciphering the surgical treatment gap for drug-resistant epilepsy (DRE): a literature review [J]. Epilepsia, 2020, 61(7): 1352-1364.
[5]WEBER J, GUSTAFSSON C, MALMGREN K, et al. Evaluation for epilepsy surgery --why do patients not proceed to operation[J]. Seizure, 2019, 69: 241-244.
[6]GUAN XD, XUE Z, MA SC, et al. Efficacy analysis of magnetic resonance-guided laser interstitial thermal therapy for the treatment of brain metastases[J]. Chin J Neurosurg, 2021, 37(8): 757-763. 管修东，薛　湛，马顺昌，等. 磁共振引导激光间质热疗治疗脑转移瘤的疗效分析[J]. 中华神经外科杂志，2021，37（8）：757-763.
[7]CHEN SC, WANG YH, FAN XT, et al. Safety and short-term efficacy of domestic magnetic resonance-guided laser interstitial thermo-therapy in the treatment of drug-resistant epilepsy[J]. Chin Med J, 2021, 101(41): 3399-3403. 陈思畅，王逸鹤，樊晓彤，等. 国产磁共振引导激光间质热疗治疗药物难治性癫痫的安全性及短期有效性观察[J]. 中华医学杂志，2021，101（41）：3399-3403.
[8]KEREZOUDIS P, PARISI V, MARSH WR, et al. Surgical outcomes of laser interstitial thermal therapy for temporal lobe epilepsy: systematic review and meta-analysis[J]. World Neurosurg, 2020, 143: 527-536.e3.
[9]WU C, JERMAKOWICZ WJ, CHAKRAVORTI S, et al. Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: a multicenter study of 234 patients[J]. Epilepsia, 2019, 60(6): 1171-1183.
[10]YOUNGERMAN BE, BANU MA, KHAN F, et al. Long-term out-comes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study[J]. J Neurol Neurosurg Psychiatry, 2023, 94(11): 879-886.
[11]CAJIGAS I, KANNER AM, RIBOT R, et al. Magnetic resonance-guided laser interstitial thermal therapy for mesial temporal epilepsy: a case series analysis of outcomes and complications at 2-year follow-up[J]. World Neurosurg, 2019, 126: e1121-e1129.
[12]JERMAKOWICZ WJ, KANNER AM, SUR S, et al. Laser thermal ablation for mesiotemporal epilepsy: analysis of ablation volumes and trajectories[J]. Epilepsia, 2017, 58(5): 801-810.
[13]ZHENG SC, QI S, YU JD, et al. Recent advance in mechanism of epilepsy induced by hypothalamic hamartoma[J]. Chin J Neuromed, 2019, 18(7): 728-731. 郑舒畅，齐　霜，余建东，等. 下丘脑错构瘤致痫神经机制的研究进展[J]. 中华神经医学杂志，2019，18（7）：728-731.
[14]SHIMAMOTO S, WU C, SPERLING MR. Laser interstitial thermal therapy in drug-resistant epilepsy[J]. Curr Opin Neurol, 2019, 32 (2): 237-245.
[15]GADGIL N, LAM S, PAN IW, et al. Staged magnetic resonance-guided laser interstitial thermal therapy for hypothalamic hamartoma: analysis of ablation volumes and morphological considerations [J]. Neurosurgery, 2020, 86(6): 808-816.
[16]CANDELA-CANT S, MUCHART J, RAMREZ-CAMACHO A, et al. Robot-assisted, real-time, MRI-guided laser interstitial thermal therapy for pediatric patients with hypothalamic hamartoma: surgical technique, pitfalls, and initial results[J]. J Neurosurg Pediatr, 2022, 29(6): 681-692.
[17]CURRY DJ, RASKIN J, ALI I, et al. MR-guided laser ablation for the treatment of hypothalamic hamartomas[J]. Epilepsy Res, 2018, 142: 131-134.
[18]WANG SS, WAN HJ, HU WH, et al. Localizing and lateralizing values of the scalp electroencephalogram in patients of epilepsy caused by focal cortical dysplasia[J]. Chin J Neurosurg, 2022, 38(9): 916-921. 王圣松，万慧娟，胡文瀚,等. 头皮脑电图在局灶性皮质发育不良所致难治性癫痫中的定位及定侧价值[J]. 中华神经外科杂志，2022，38（9）：916-921.
[19]YOUNGERMAN BE, SAVE AV, MCKHANN GM. Magnetic reso-nance imaging-guided laser interstitial thermal therapy for epilepsy: systematic review of technique, indications, and outcomes[J]. Neurosurgery, 2020, 86(4): E366-E382.
[20]GUPTA K, CABANISS B, KHEDER A, et al. Stereotactic MRI-guided laser interstitial thermal therapy for extratemporal lobe epilepsy[J]. Epilepsia, 2020, 61(8): 1723-1734.
[21]XU YW, CHEN ZY, ZHU YZ, et al. Comparative analysis of efficacy and safety of surgery and drugs in the treatment of epilepsy caused by cerebral cavernous vascular malformation[J]. J Sun Yat-sen Univ (Med Sci), 2021, 42(2): 266-270. 许育伟，陈子怡，朱燕珍，等. 对比手术与药物治疗脑海绵状血管畸形所致癫痫的疗效与安全性分析[J]. 中山大学学报（医学科学版），2021，42（2）：266-270.
[22]YOUSEFI O, SABAHI M, MALCOLM J, et al. Laser interstitial thermal therapy for cavernous malformations: a systematic review [J]. Front Surg, 2022, 9: 887329-887336.
[23]OGASAWARA C, WATANABE G, YOUNG K, et al. Laser interstitial thermal therapy for cerebral cavernous malformations: a system-atic review of indications, safety, and outcomes[J]. World Neuro-surg, 2022, 166: 279-287.e1.
[24]SATZER D, TAO JX, ISSA NP, et al. Stereotactic laser interstitial thermal therapy for epilepsy associated with solitary and multiple cerebral cavernous malformations[J]. Neurosurg Focus, 2020, 48(4): E12-E20.
[25]BAROT N, BATRA K, ZHANG J, et al. Surgical outcomes between temporal, extratemporal epilepsies and hypothalamic hamartoma: systematic review and meta-analysis of MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy[J]. J Neurol Neuro-surg Psychiatry, 2022, 93(2): 133-143.
[26]KONDAJJI AM, EVANS A, LUM M, et al. A systematic review of stereotactic radiofrequency ablation for hypothalamic hamartomas [J]. J Neurol Sci, 2021, 424: 117428-117434.
[27]KOHLHASE K, ZOLLNER JP, TANDON N, et al. Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: a systematic review and meta-analysis of outcomes[J]. Epilepsia, 2021, 62(4): 831-845.
[28]ZHANG BQ, WANG HY, FNEG Q, et al. Primary observation of clinical efficacy of radiofrequency thermocoagulation guided by stereotactic electroencephalography for the treatment of epilepsy due to perinatal brain injury[J]. Chin J Neurosurg, 2023, 39(8): 799-803. 张冰清，王海祥，丰　倩，等. 立体脑电图引导下射频热凝消融术治疗围生期脑损伤后癫痫的初步疗效观察[J]. 中华神经外科杂志，2023，39（8）：799-803.
[29]FAN YF, GENG MY. Correlation occurrence of radiation induced encephaledema with target dose and volume in stereotactic radio-surgery of epilepsy[J]. Chin J Radiol Med Protec, 2015, 35(7): 528-531. 樊跃飞，耿明英. 立体定向放射外科治疗癫痫的剂量-体积与脑水肿的相关性研究[J]. 中华放射医学与防护杂志，2015，35（7）：528-531.
[30]MARATHE K, ALIM-MARVASTI A, DAHELE K, et al. Resective, ablative and radiosurgical interventions for drug resistant mesial temporal lobe epilepsy: a systematic review and meta-analysis of outcomes[J]. Front Neurol, 2021, 12: 777845-777861.
[31]GREWAL SS, ALVI MA, LU VM, et al. Magnetic resonance-guided laser interstitial thermal therapy versus stereotactic radiosurgery for medically intractable temporal lobe epilepsy: a systematic review and meta-analysis of seizure outcomes and complications[J]. World Neurosurg, 2019, 122: e32-e47.
[32]ZOU JJ, LIN ZR, NIU LL, et al. Application and principle of focused ultrasound in the treatment of central nervous system diseases, such as epilepsy[J]. Chin J Neuromed, 2018, 17(2): 212-216. 邹俊杰，林争荣，牛丽丽，等. 聚焦超声在癫痫等中枢神经系统疾病治疗中的应用及机制[J]. 中华神经医学杂志，2018，17（2）：212-216.
[33]LESCRAUWAET E, VONCK K, SPRENGERS M, et al. Recent advances in the use of focused ultrasound as a treatment for epilephy [J]. Front Neurosci, 2022, 16: 886584-886593.
[34]LEE CC, CHOU CC, HSIAO FJ, et al. Pilot study of focused ultra-sound for drug-resistant epilepsy[J]. Epilepsia, 2022, 63(1): 162-175.
[35]JAMY R, KAUR M, PIZARRO D, et al. Practice trends and the out-come of neuromodulation therapies in epilepsy: a single-center study[J]. Epilepsia Open, 2019, 4(3): 493-497.
[36]GONZOLEZ HFJ, YENGO-KAHN A, ENGLOT DJ. Vagus nerve stimulation for the treatment of epilepsy[J]. Neurosurg Clin N Am, 2019, 30(2): 219-230.
[37]TOFFA DH, TOUMA L, EL MESKINE T, et al. Learnings from 30 years of reported efficacy and safety of vagus nerve stimulation (VNS) for epilepsy treatment: a critical review[J]. Seizure, 2020, 83: 104-123.
[38]LIM MJR, FONG KY, ZHENG Y, et al. Vagus nerve stimulation for treatment of drug-resistant epilepsy: a systematic review and meta-analysis[J]. Neurosurg Rev, 2022, 45(3): 2361-2373.
[39]YANG ZY, LIU DY, YANG ZQ, et al. Efficacy and safety of vagus nerve stimulation in the treatment of refractory epilepsy[J]. J Cent South Univ (Med Sci), 2021, 46(10): 1096-1101. 杨转移，刘定阳，杨治权，等. 迷走神经刺激术治疗难治性癫痫的疗效和安全性[J]. 中南大学学报（医学版），2021，46（10）：1096-1101.
[40]ZANGIABADI N, LADINO LD, SINA F, et al. Deep brain stimulation and drug-resistant epilepsy: a review of the literature[J]. Front Neurol, 2019, 10: 601-618.
[41]YU T, WANG X, LI Y, et al. High-frequency stimulation of anterior nucleus of thalamus desynchronizes epileptic network in humans [J]. Brain, 2018, 141(9): 2631-2643.
[42]SOBSTYL M, STAPIOSKA-SYNIEC A, RYLSKI M. Deep brain stimulation for the treatment of refractory and super-refractory status epilepticus[J]. Seizure, 2020, 81:58-62.
[43]SALANOVA V, SPERLING MR, GROSS RE, et al. The SANT study at 10 years of follow-up: effectiveness, safety, and sudden unexpected death in epilepsy[J]. Epilepsia, 2021, 62(6): 1306-1317.
[44]MUTHAFFAR OY. Treating epilepsy with options other than anti-epileptic medications[J]. Neurosciences (Riyadh), 2020, 25(4): 253-261.
[45]ROA JA, ABRAMOVA M, FIELDS M, et al. Responsive neurosti-mulation of the thalamus for the treatment of refractory epilepsy[J]. Front Hum Neurosci, 2022, 16: 926337-926344.
[46]MORTAZAVI A, ELLIOTT RS, PHAN TN, et al. Responsive neuro-stimulation for the treatment of medically refractory epilepsy in pediatric patients: strategies, outcomes, and technical considerations [J]. J Neurosurg Pediatr, 2021, 28(1): 54-61.
[47]KUSYK DM, MEINERT J, STABINGAS KC, et al. Systematic review and meta-analysis of responsive neurostimulation in epilepsy [J]. World Neurosurg, 2022, 167: e70-e78.

相似文献/References:

[1]景慎东,胡延霞,李宪峰.尿激酶在微创手术治疗慢性硬膜下血肿中的作用[J].中国临床神经外科杂志,2016,(11):707.[doi:10.13798/j.issn.1009-153X.2016.11.020]
[2]郑　玺　顿晓熠.迷走神经刺激术对药物难治性癫痫患者认知功能的影响及其相关因素分析[J].中国临床神经外科杂志,2017,(03):142.[doi:10.13798/j.issn.1009-153X.2017.03.005]
　ZHENG Xi,DUN Xiao-yi..Observation of cognitive function and analysis of factors related to it in patients with intractable epilepsy after treatment by vagus nerve stimulation[J].,2017,(08):142.[doi:10.13798/j.issn.1009-153X.2017.03.005]
[3]张王成 综述　黄书岚 审校.成人难治性部分发作性癫痫的药物治疗研究进展[J].中国临床神经外科杂志,2017,(03):197.[doi:10.13798/j.issn.1009-153X.2017.03.028]
[4]汪超甲　王　辉.微创手术和保守治疗高血压性脑出血疗效的Meta分析[J].中国临床神经外科杂志,2017,(05):296.[doi:10.13798/j.issn.1009-153X.2017.05.004]
　WANG Chao-jia,WANG Hui..Meta analyses of curative effects on hypertensive cerebral hemorrhage: minimally invasive surgery versus conservative treatment[J].,2017,(08):296.[doi:10.13798/j.issn.1009-153X.2017.05.004]
[5]闵　强　何主强　彭文茜.实时CT监控下钻孔抽吸术治疗高血压性脑出血[J].中国临床神经外科杂志,2017,(05):348.[doi:10.13798/j.issn.1009-153X.2017.05.024]
[6]关宇光　于思科　刘长青　张　尧　陈思畅　丁浩然　周　健　栾国明.立体定向脑电图引导下射频热凝毁损术治疗药物难治性癫痫[J].中国临床神经外科杂志,2017,(06):369.[doi:10.13798/j.issn.1009-153X.2017.06.001]
　GUAN Yu-guang,YU Si-ke,LIU Chang-qing,et al.Stereotatic EEG-guided radio-frequency thermocoagulation of epileptogenic zones in the patients with refractory epilepsy[J].,2017,(08):369.[doi:10.13798/j.issn.1009-153X.2017.06.001]
[7]杜秀玉 综述　栾国明 审校.大脑半球切除术后脑可塑性的研究进展[J].中国临床神经外科杂志,2017,(06):391.[doi:10.13798/j.issn.1009-153X.2017.06.008]
[8]陈俊喜　郭　强　谭红平　王艮波　华　刚.ROSA引导下立体定向脑电图在儿童难治性癫痫手术中作用[J].中国临床神经外科杂志,2017,(09):623.[doi:10.13798/j.issn.1009-153X.2017.09.005]
　CHEN Jun-xi,GUO Qiang,TAN Hong-ping,et al.Application of ROSA-guided stereoelectroencephalography surgery for intractable epilepsy in children[J].,2017,(08):623.[doi:10.13798/j.issn.1009-153X.2017.09.005]
[9]王逸鹤　赵国光　单永治　樊晓彤　安　阳　卢　超.局灶性皮质发育不良致药物难治性癫痫的手术预后及其影响因素[J].中国临床神经外科杂志,2017,(11):737.[doi:10.13798/j.issn.1009-153X.2017.11.001]
　WANG Yi-he ZHAO Guo-guang,SHAN Yong-zhi,FAN Xiao-tong,et al.Analysis of factors related to postoperative prognoses in focal cortical dysplasia patients with refractory epilepsy[J].,2017,(08):737.[doi:10.13798/j.issn.1009-153X.2017.11.001]
[10]徐德辉　谢海涛　伍犹梁　谢学敏　余佳彬　张晓静　隋立森　赵　敏.脑灰质异位合并巨脑回及海马硬化致药物难治性癫痫1例[J].中国临床神经外科杂志,2019,(01):64.[doi:10.13798/j.issn.1009-153X.2019.01.022]

备注/Memo

备注/Memo:
（2023-11-30收稿，2024-04-22修回）
基金项目：衡水市科技计划（2022014083Z）
更新日期/Last Update: 2024-08-30