Study Of The Long-term Effect Of Frontal Or Temporal Lobe Isolation Surgery On Refractory Epilepsy

Objectives: Frontal and temporal lobe epilepsy are common in refractory epilepsy.They are also common types of surgical treatment for epilepsy.Surgical methods lead to resection of epileptic focus,but for cases where the epileptogenic focus can only be located in the lobe but cannot be accurately located,or who have poor results after epileptogenic focus resection,it is often necessary to remove the entire cerebral hemisphere or multilobes(such as frontal lobe,temporal lobe,etc).Although single lobectomy does not often lead to serious brain complications such as brain shift,hydrocephalus or hemosiderin deposition,it still has complications such as large trauma,long operation time,and infection.The literatures show that the effect of Periinsular hemispherotomy can be equivalent to the effect of resection surgery,while the single lobe incision surgery is less reported.In this paper,long-term follow-up of patients with disconnection surgery of frontal or temporal lobe was used to evaluate the efficacy of the surgery and analysis of surgical indications.Methods: The clinical data of eight patients with refractory epilepsy undergoing disconnection surgery of frontal or temporal lobe from March 2013 to December 2014 in Tianjin Huanhu Hospital were retrospectively analyzed,including the epilepsy control rate and the incidence of complications.Three of the patients were treated with prefrontal lobe isolation,4 cases were treated with frontal temporal lobe,and 1 case was performed with frontal lobe combined with temporal lobe lobe isolation.One patient died after surgery,and all the remaining 7 patients were followed up for 30-51 months(mean 37.9 months).Results: According to the modified Engel classification,the improvement of the postoperative post-mitigation seizure control was assessed.The results were Engel I in 6 cases and Engel III in 1 case.In addition,3 patients found quadrant blindness after specialist examination but were not aware of it.Conclusion: Disconnection surgery of frontal or temporal lobe is a safe and effective surgical method for the treatment of frontal or temporal lobe on drugrefractory epilepsy.The principle is based on the complete separation of nerve fibers in the brain tissue from epileptogenic zone and other brain regions.While retaining its biological activity,it isolates the epileptogenic region and blocks the conduction pathway of epileptiform discharge.The postoperative epilepsy control rate is comparable to that of resection surgery and lobectomy,and it greatly reduces the volume of brain resection and reduces the occurrence of related complications.However,caution should be exercised in the selection of indications,especially for elderly patients who have undergone joint surgery for isolated frontal and temporal lobes.