1
|
Barba C, Giometto S, Lucenteforte E, Pellacani S, Matta G, Bettiol A, Minghetti S, Falorni L, Melani F, Di Giacomo G, Giordano F, De Masi S, Guerrini R. Seizure Outcome of Temporal Lobe Epilepsy Surgery in Adults and Children: A Systematic Review and Meta-Analysis. Neurosurgery 2022; 91:676-683. [PMID: 35960753 DOI: 10.1227/neu.0000000000002094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Temporal lobe epilepsy (TLE) surgery is associated with the best seizure outcome in adults, although its long-term results remain suboptimal. Retrospective pediatric studies suggest better figures whose determinants are poorly understood. OBJECTIVE To conduct a systematic review and meta-analysis of studies on the efficacy of TLE surgery in children (age younger than 18 years) and adults. METHODS We searched MEDLINE, Embase, and Cochrane Library for TLE surgery original research from January 1, 1990, until May 12, 2020. The outcome measures were seizure freedom since surgery and seizure freedom either at last or longest follow-up. We meta-analyzed the proportion of children and adults achieving either Engel I/International League Against Epilepsy (ILAE) 1 or Engel IA/ILAE 1A outcome by follow-up duration, type of surgery, histopathology, neuroimaging, quality of the studies, and publication period. We used a random effects model with Freeman-Tukey double arcsine transformation of proportions. RESULTS From 40 409 records identified, we included 277 studies (30 848 patients). The proportions of patients achieving Engel I/ILAE 1 and Engel IA/ILAE 1A outcomes were 0.74 (95% CI, 0.69-0.78) and 0.61 (0.48-0.74) for children and 0.69 (0.67-0.71) and 0.56 (0.52-0.60) for adults. Histopathology significantly influenced Engel I/ILAE 1 outcome in adults but not in children (P < .0001), while the type of surgery significantly influenced Engel I/ILAE 1 outcome in children but not in adults. CONCLUSION The proportion of seizure freedom after TLE surgery was higher in children, although not significantly. Histopathology and the surgical approach can influence seizure outcome, with age-related variability.
Collapse
Affiliation(s)
- Carmen Barba
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy.,University of Florence, Florence, Italy
| | - Sabrina Giometto
- Unit of Medical Statistic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Pellacani
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Giulia Matta
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Minghetti
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Lavinia Falorni
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Federico Melani
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | | | - Flavio Giordano
- University of Florence, Florence, Italy.,Neurosurgery Department, Meyer Children's Hospital, Florence, Italy
| | | | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital, Florence, Italy.,University of Florence, Florence, Italy
| |
Collapse
|
2
|
Giordano F, Lenge M, Donati P, Mongardi L, Di Giacomo G, Mura R, Taverna M, Cini C, Peraio S, Poggi G, Tuccinardi G, Giglio S, Genitori L. Exclusive Neurogenic Bladder and Fecal Incontinency in an Achondroplasic Child Successfully Treated with Lumbar Foraminal Decompression. Pediatr Neurosurg 2021; 56:471-476. [PMID: 34320505 DOI: 10.1159/000517652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/06/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Achondroplasia is a genetic disorder characterized by defects in the development of endochondral bone resulting in skeletal abnormalities like stenosis of the foramen magnum and of the spine, shortened limb bones, and macrocephaly. Congenital spinal stenosis is frequent and due to premature fusion of the pedicles to the laminae. CASE PRESENTATION We report a case of neurogenic bladder and fecal incontinence due to lumbar stenosis successfully treated with L1-L5 partial laminectomy and foraminotomy in a 7-year-old achondroplasic child. DISCUSSION/CONCLUSION To our knowledge, this is the first case report of exclusive neurogenic bladder and fecal incontinence in an achondroplasic child. Neurogenic bladder and fecal incontinence without motor impairment may be early and exclusive clinical findings of lumbar stenosis in children with achondroplasia.
Collapse
Affiliation(s)
- Flavio Giordano
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Matteo Lenge
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy, .,Department of Neuroscience, Child Neurology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy,
| | - Pierarturo Donati
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, Nuovo Ospedale Cona, University of Ferrara, Ferrara, Italy
| | - Gianpiero Di Giacomo
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,Department of Neuroscience, Child Neurology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Regina Mura
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Maria Taverna
- Department of Surgery, Pediatric Urology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Chiara Cini
- Department of Surgery, Pediatric Urology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Simone Peraio
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Giovanni Poggi
- Department of Pediatrics, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Germana Tuccinardi
- Neuroanesthesiology Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Sabrina Giglio
- Clinical Genetics Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Lorenzo Genitori
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| |
Collapse
|