Purpose: To report complications after epilepsy surgery, grade the severity of complications, investigate risk factors, and develop a nomogram for risk prediction of complications. Methods: Patients with epilepsy surgery performed by a single surgeon at a single center between October 1, 2003 and April 30, 2019 were retrospectively analyzed. Study outcomes included severity grading of complications occurring during the 3-month period after surgery, risk factors, and a prediction model of these complications. Multivariable logistic regression analysis was used to calculate odds ratio and 95% confidence interval to identify risk factors. Results: In total, 2,026 surgical procedures were eligible. There were 380 patients with mild complications, 23 with moderate complications, and 82 with severe complications. Being male (odds ratio 1.29, 95% confidence interval 1.02-1.64), age at surgery (>40 years: 2.58, 1.55-4.31; ≤ 40: 2.25, 1.39-3.65; ≤ 30: 1.83, 1.18-2.84; ≤ 20: 1.71, 1.11-2.63), intracranial hemorrhage in infancy (2.28, 1.14-4.57), serial number of surgery ( ≤ 1,000: 1.41, 1.01-1.97; ≤ 1,500: 1.63, 1.18-2.25), type of surgical procedure (extratemporal resections: 2.04, 1.55-2.70; extratemporal plus temporal resections: 2.56, 1.80-3.65), surgery duration (>6 h: 1.94, 1.25-3.00; ≤ 6: 1.92, 1.39-2.65), and acute postoperative seizure (1.44, 1.06-1.97) were independent risk factors of complications. A nomogram including age at surgery, type of surgical procedure, and surgery duration was developed to predict the probability of complications. Conclusions: Although epilepsy surgery has a potential adverse effect on the patients, most complications are mild and severe complications are few. Risk factors should be considered during the perioperative period. Patients with the above risk factors should be closely monitored to identify and treat complications timely. The prediction model is very useful for surgeons to improve postoperative management.
Background It has been shown that circular RNAs (circRNAs) play a vital role in the progression of glioma. Recently, hsa_circ_0001836 was found to be upregulated in glioma tissues, but the role of hsa_circ_0001836 in glioma remains unclear. Methods EdU staining and flow cytometry assays were used to measure the viability and death of glioma cells. In addition, scanning electron microscopy (SEM) was used to observe the morphology of cells undergoing cell death. Results Hsa_circ_0001836 expression was upregulated in U251MG and SHG-44 cells. In addition, hsa_circ_0001836 knockdown significantly reduced the viability and proliferation of U251MG and SHG-44 cells. Moreover, hsa_circ_0001836 knockdown markedly induced the pyroptosis of U251MG and SHG-44 cells, evidenced by the increased expressions of NLRP1, cleaved caspase 1 and GSDMD-N. Meanwhile, methylation specific PCR (MSP) results indicated that hsa_circ_0001836 knockdown epigenetically increased NLRP1 expression via mediating DNA demethylation of NLRP1 promoter region. Furthermore, downregulation of hsa_circ_0001836 notably induced pyroptosis and inhibited tumor growth in a mouse xenograft model of glioma. Conclusion Collectively, hsa_circ_0001836 knockdown could induce pyroptosis cell death in glioma cells in vitro and in vivo via epigenetically upregulating NLRP1 expression. These findings suggested that hsa_circ_0001836 may serve as a potential therapeutic target for the treatment of glioma.
Corpus callosotomy is a palliative surgery for medically refractory epilepsy. We aim to analyze the clinical features of patients with seizure freedom and failure after total corpus callosotomy for childhood-onset refractory epilepsy.We retrospectively reviewed the clinical courses of patients with childhood-onset refractory epilepsy undergoing total corpus callosotomy between May 2009 and March 2019. Seizure outcome at the last follow-up was the primary outcome. The clinical features of patients with seizure freedom and failure after callosotomy were compared.Eighty patients with childhood-onset refractory epilepsy underwent total corpus callosotomy; 15 (18.8%) obtained freedom from all seizures and 19 (23.8%) had unworthwhile improvement and failure. The mean ages at seizure onset in patients with seizure freedom and failure after callosotomy were 5.7 and 5.9 years; and mean seizure durations were 9.4 and 11.5 years, respectively. Univariate analysis found epilepsy syndrome (p = 0.047), mental retardation (p = 0.007), previous medical history (p = 0.004), ≥10 seizures per day (p = 0.024), theta waves in the background electroencephalogram (p = 0.024), and acute postoperative seizure (p = 0.000) were associated with failure after callosotomy. Seizure freedom after callosotomy was more common among patients with less than 10 seizures per day.Total corpus callosotomy is an effective palliative procedure for childhood-onset refractory epilepsy, particularly for patients with specific clinical characteristics. Callosotomy has a high seizure-free rate in well-selected patients.
Abstract The predictors of long-term seizure outcomes after resectivesurgery for focal epilepsy, for an update on the features of good and poor outcomes is investigated. A retrospective study of patients with focal epilepsy undergoing resectivesurgery from March 2011 toApril 2019 was performed. There were 3 groups according to the seizure outcomes: group A, seizure freedom; group B, seizure improvement; group C, no improvement. Five comparisons were performed: comparison 1, A vs. B and C; comparison 2, A vs. B; comparison 3, A vs. C; comparison 4, B vs. C; comparison 5, A and B vs. C. Predictors of seizure outcomes were identified by multivariate logistic regression analysis. Of all 833 patients, 561 (67.3%) patients remained seizure-free at the last follow-up, 203 (24.4%) patients had seizure improvement, and 69 (8.3%) had no improvement. The mean follow-up duration was 5.2 years (range: 2.7 to 9.6). Predictors of better outcomes included epilepsyduration <5 years (comparisons 1-3), localized discharge (comparisons 1 and 2), no. of antiepileptic drugs at surgery <3 (comparison 5), and temporal lobe resection (comparisons 1 and 3). However, predictors of worse outcomes included intracranial haemorrhage in infancy (comparisons 1 and 2), interictal abnormal discharge (comparisons 1 and 2), intracranial electrode monitoring (comparisons 1 and 2), and acute postoperative seizure (all comparisons). Our study suggests that resectivesurgery for focal epilepsy has satisfactory outcomes. Short epilepsy duration, localized discharge, and temporal lobe resection are positive predictors of seizure freedom. Patients with these predictors are intensivelyrecommended for surgery.
BACKGROUND: Anterior temporal lobectomy is the most effective treatment for intractable temporal lobe epilepsy (TLE). However, patients are reluctant to choose this surgery for fear of risks after large frontotemporal craniotomy, and epileptologists likewise have a cautious attitude because of surgical trauma. Functional anterior temporal lobectomy (FATL) is a minimally invasive surgery procedure for addressing the above concerns. OBJECTIVE: To report preliminary data on this procedure and its safety and efficacy for treating TLE. METHODS: This consecutive case series study was conducted between October 2020 and September 2021. Patients with TLE underwent FATL by minicraniotomy with a diameter of 3 cm. Surgery duration, postoperative complications, and seizure control are described herein. Seizure outcomes were classified using Engel classifications. RESULTS: A total of 25 patients undergoing FATL for TLE were enrolled. The median epilepsy duration was 8 years. The median surgery duration was 165 min. The median blood loss was 100 mL. The median postoperative hospital stay was 8 days. No deaths occurred after surgery. Only 1 patient presented with a cerebrospinal fluid disorder that was successfully treated using a ventriculoperitoneal shunt. At the last follow-up, 23 patients (92%) were seizure-free (Engel-Ia), 1 patient remained substantially improved (Engel-II), and 1 patient obtained worthwhile seizure reduction (Engel-III). CONCLUSION: Our pilot study suggests that FATL is a viable surgical therapy for TLE. This method has the advantages of minimal invasiveness and high seizure-free rate. A controlled trial is warranted to verify the efficacy and safety of FATL comparing with anterior temporal lobectomy.
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