医学
癫痫外科
癫痫
外科
置信区间
比例危险模型
光环
回顾性队列研究
生存分析
麻醉
内科学
精神科
偏头痛
作者
Alaa Eldin Elsharkawy,F. Behne,Falk Oppel,Heinz Pannek,Reinhard Schulz,M. Hoppe,Gerald Pahs,Csilla Gyimesi,Mohamed H. Nayel,Ahmed S. Issa,Alois Ebner
出处
期刊:Journal of Neurosurgery
[American Association of Neurological Surgeons]
日期:2008-03-31
卷期号:108 (4): 676-686
被引量:83
标识
DOI:10.3171/jns/2008/108/4/0676
摘要
The goal of this study was to evaluate the long-term outcome of patients who underwent extratemporal epilepsy surgery and to assess preoperative prognostic factors associated with seizure outcome.This retrospective study included 154 consecutive adult patients who underwent epilepsy surgery at Bethel Epilepsy Centre, Bielefeld, Germany between 1991 and 2001. Seizure outcome was categorized based on the modified Engel classification. Survival statistics were calculated using Kaplan-Meier curves, life tables, and Cox regression models to evaluate the risk factors associated with outcomes.Sixty-one patients (39.6%) underwent frontal resections, 68 (44.1%) had posterior cortex resections, 15 (9.7%) multilobar resections, 6 (3.9%) parietal resections, and 4 (2.6%) occipital resections. The probability of an Engel Class I outcome for the overall patient group was 55.8% (95% confidence interval [CI] 52-58% at 0.5 years), 54.5% (95% CI 50-58%) at 1 year, and 51.1% (95% CI 48-54%) at 14 years. If a patient was in Class I at 2 years postoperatively, the probability of remaining in Class I for 14 years postoperatively was 88% (95% CI 78-98%). Factors predictive of poor long-term outcome after surgery were previous surgery (p = 0.04), tonic-clonic seizures (p = 0.02), and the presence of an auditory aura (p = 0.03). Factors predictive of good long-term outcome were surgery within 5 years after onset (p = 0.015) and preoperative invasive monitoring (p = 0.002).Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.
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