RESUMEN
We report here the results of the first survey on epilepsy surgery activity in France. Data from a questionnaire sent to 17 centers practicing epilepsy surgery were analyzed. All centers responded; however, all items were not completely documented. Over 50 years, more than 5000 patients have been operated on for drug-resistant epilepsy and more than 3000 patients underwent some invasive monitoring, most often SEEG. Currently, nearly 400 patients (including more than 100 children) are operated on yearly for epilepsy in France. Over a study period varying among centers (from two to 20 years; mean, 9.5 years), results from more than 2000 patients including one-third children were analyzed. Important differences between adults and children, respectively, were observed in terms of location (temporal: 72% versus 4.3%; frontal: 12% versus 28%; central: 2% versus 11%), etiology (hippocampal sclerosis: 41% versus 2%; tumors 20% versus 61%); and procedures (cortectomy: 50% versus 23%; lesionectomy: 8% versus 59%), although overall results were identical (seizure-free rates following temporal lobe surgery: 80.6% versus 79%; following extratemporal surgery: 65.9% versus 65%). In adults, the best results were observed following temporomesial (TM) resection associated with hippocampal sclerosis or other lesions (class I: 83% and 79%, respectively), temporal neocortical (TNC) lesional (82%), while resections for cryptogenic temporal resections were followed by 69% (TM) and 63% (TNC) class I outcome. Extratemporal lesional resections were associated with 71% class I outcome and cryptogenic 43%. In children, the best results were obtained in tumor-associated epilepsy regardless of location (class I: 80%). A surgical complication occurred in 8% after resective surgery - with only 2.5% permanent morbidity - and 4.3% after invasive monitoring (mostly hemorrhagic). Overall results obtained by epilepsy surgery centers were in the higher range of those reported in the literature, along with a low rate of major surgical complications. Growing interest for epilepsy surgery is clearly demonstrated in this survey and supports further development to better satisfy the population's needs, particularly children. Activity should be further evaluated, while existing epilepsy surgery centers as well as healthcare networks should be expanded.
Asunto(s)
Epilepsia/cirugía , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Adulto , Encéfalo/patología , Niño , Electroencefalografía , Epilepsia/epidemiología , Epilepsia/patología , Francia/epidemiología , Encuestas de Atención de la Salud , Humanos , Monitoreo Intraoperatorio , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/epidemiología , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
We report a multicentric outcome study of cerebral metastases in 174 patients collected consecutively in three neurosurgical centers in France. Age and condition of patients allowed surgical operation; the sex ratio was 1.67. The revelation mode was usual. However tumoral hemorrhage frequency was 3.4%. Primitive cancers were usual cancers as in oncological series with a higher proportion of radioresistant metastases. Mean dimension was 30 mm with mean of 1. 25 metastases per patient. Supratentorial localization was more frequent and the metastasis revealed cancer in 40% of cases. Global median survival was 12.1 months. Factors correlated with the survival in our series of patients with cerebral metastases were: solitary cerebral metastasis, extracerebral extension of cancer, treatment of primitive cancer, complete excision and post operative cerebral radiotherapy.