Trends in epilepsy surgery in Italy before and after the COVID-19 pandemic: A nationwide study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Didato Giuseppe, Vigevano Federico, Tassi Laura, Guerrini Renzo, de Curtis Marco, De Palma Luca, Di Gennaro Giancarlo, Nobili Lino, Martinoni Matteo, Meletti Stefano, Battaglia Domenica, Cesaroni Elisabetta, Vittorini Roberta, Grisotto Laura, d'Orsi Giuseppe, Dilena Robertino, Pingue Valeria, Nardone Antonio, Ranzato Federica, Zucca Claudio, Bonanni Paolo, Mattioli Pietro, Tamburrini Gianpiero, Quintiliani Michela, Luzi Michele, Trignani Roberto, Torta Francesca, Morana Giovanni, Pugnaghi Matteo, Vaudano Anna Elisabetta, Bisulli Francesca, Pasini Elena, Consales Alessandro, Nobile Giulia, Esposito Vincenzo, Quarato Pier Paolo, Freri Elena, Marras Carlo Efisio, Giordano Flavio, Pelliccia Veronica, Castana Laura, Specchio Nicola, Costantino Umberto, Pluderi Mauro, Rizzi Michele, Polo Diana, Zambrano Stefania, Danieli Alberto, Villani Flavio, Barba Carmen, Italian Epilepsy Surgery Collaborative Group
Аннотация
METHODS: We launched a survey through the Italian National Virtual Epilepsy Institute, to identify centers with epilepsy surgery programs and collect data on the current preoperative and surgical practices. We reported changes in surgical volumes and complications and seizure outcomes between 2018 and 2022, that is, before and after the COVID-19 pandemic in Italy.
RESULTS: A total of 21 of the 26 surveyed centers (80.7%) responded. Eleven centers (52.4%) reported having an established epilepsy surgery program, with most performing complex procedures, such as multilobar, disconnective, and hemispheric interventions. However, only a few carry out minimally invasive surgeries. Presurgical evaluation protocols vary across centers, but in keeping with international standards. Globally, 618 surgeries were performed in children and 621 in adults (total 1239) between 2018 and 2022. The most frequent type of surgery was unilobar extratemporal lobectomy for children (38.7%, p < 0.0001) and unilobar temporal lobectomy for adults (63.3%, p < 0.0001). Hemispheric surgeries were more frequent in children than in adults (11.5% vs 2.1%, p = 0.001), whereas interventions in unrevealing magnetic resonance (MRI) cases were more frequent in adults than in children (p = 0.030). At the onset of COVID-19outbreak in Italy (March 2020), we observed a significant decrease in the total number of operations compared to 2019, especially for hemispheric interventions (p = 0.027). Surgical volumes resumed in 2021, particularly for temporal lobe epilepsies and in adult cohorts. Surgical complications increased significantly in 2020 (Incidence Rate Ratio [IRR] = 13.13), whereas seizure outcome did not change significantly between 2018 and 2022.
SIGNIFICANCE: Advanced pre- and postsurgical evaluation protocols are currently implemented across Italy, with a great variability between centers. Starting in 2021, epilepsy surgery volumes have regained their pre-pandemic levels, albeit with a slight loss of complexity, whereas seizure outcome has remained stable.