간질 수술의 합병증과 그 대책

Abstract

A unique feature of epilepsy surgery among the neurosurgical specialties is that removal(resective surgery) or disconnection(corpus callosotomy) of functional brain regions are often essential elements of the operative strategies. This requirement for resection and disconnection of functional brain areas in patients suffering from medically intractable epilepsy may engender postoperative “neurobehavioral complications” including neurological, neuropsychological, psychosocial and psychiatric impairments. Preoperative evaluation including the comprehensive neuropsychological assessment and intracarotid Amytal procedure(IAP) as well as ictal monitoring methods, identify favorable candidates for epilepsy surgery and assist the surgical team in achieving optimum seizure relief while at the same time avoiding significant deficits. Complications pertinent to inadequacies in the neuropsychological evaluation, especially in temporal lobe resection candidates, encompass global or material-specific memory deficit, and cognitive losses following resective surgery. The extra-temporal epilepsies considered for resective therapy are less frequent, more variable in their presentation, and are associated with a less favorable seizure outcome postoperatively than is the case for temporal lobe epilepsy. Furthermore, the epileptogenic zone is more likely to infringe upon essential cortical areas, thus intraoperative or extraoperative brain mapping is often necessary. All of these considerations have a direct bearing upon the complications of extratemporal resections, not the least of which are the potential functional implications of adequate removal of the epileptogenic zone in a particular brain area. Thus, a consideration of the “complications of epilepsy surgery” must embrace complications attributable to inadequacies during the phase of preoperative evaluation and diagnostic epilepsy surgery, as well as complications attributable to the definitive surgical intervention itself.