Clinicopathological study on refractory epilepsy treated by several epilepsy surgeries

Objective To observe and investigate the clinicopathological features and types of refractory epilepsy treated by several epilepsy surgeries. Methods There were 19 patients with age less than 20 years who underwent 2 (16/19) or 3 (3/19) epilepsy surgeries. After pathological examination, pathological diagnosis and subtype was made according to focal cortical dysplasia (FCD) classification proposed by International League Against Epilepsy (ILAE) Diagnostic Methods Commission in 2011 and World Health Organization (WHO) Classification of Tumors of Central Nervous System in 2007. Results The operation intervals were 1-10 years (average 4.24 years). The pathological diagnoses after first operation were FCDⅠb in 2 cases (2/19), FCDⅡa in 2 cases (2/19), FCDⅢa in one case (1/19), FCDⅢd in one case (1/19), 5 cases of tumor lesions [2 (2/19) of astrocytoma, one (1/19) of oligoastrocytoma, one (1/ 19) of mixed germ cell tumor, one (1/19) of hysembryoplastic neuroepithelial tumor (DNT)], one case (1/19) of hamartoma, one case (1/19) of angioma, one case (1/19) of heterotopic gray matter, and 4 cases (4/19) of ulegyria. The last one (1/19) underwent corpus callosal incision. Pathological diagnoses after reoperation were FCDⅢa in 4 cases (4/19), FCDⅢb in 4 cases (4/19), FCDⅢc in one case (1/19), FCDⅢd in 8 cases (8/19), dual pathology (FCDⅢa with oligoastrocytoma and with glial scar and/or ulegyria) in 2 cases (2/19). Patients were followed up for 0.50-5.00 years after second or third operation (average 2.34 years), and the results showed Engel Ⅰ in 10 patients (10/19), Engel Ⅱ in 6 patients (6/19) and Engel Ⅲ in 3 patients (3/19). The rate of good prognosis was 84.21%. Conclusions The pathological diagnoses of brain tissue resected from patients accepting several epilepsy surgeries are mainly FCD Ⅲ and dual pathology. It is suggested that the second or third operation would be effective for refractory epilepsy patients who underwent surgery already. DOI: 10.3969/j.issn.1672-6731.2018.02.01