以癫痫发作为主的脑内海绵状血管畸形的手术治疗

目的 评估合并癫痫的海绵状血管畸形患者的手术治疗方法。方法 采用回顾性研究，收集我科住院的合并癫痫的海绵状血管畸形患者27例，对行完整切除海绵状血管畸形病灶（包括病灶周边的胶质瘢痕层和含铁血黄素层）和完整切除海绵状血管畸形病灶+皮层热灼治疗患者的癫痫预后及其他相关因素进行比较。结果 ①完整切除病灶+皮层热灼术患者的癫痫预后明显好于仅完整切除病灶的患者（P =0.036）。②癫痫患病病程不足1年患者预后明显好于癫痫患病病程超过1年的患者（P =0.022）。③性别、年龄、病灶所在脑叶、癫痫发作形式、术前是否应用抗癫痫药物（antiepileptic drugs，AEDs）及术后功能状态评分（Karnofsky Performance Status Scale，KPS）对癫痫预后无显著影响。结论 对于合并癫痫的海绵状血管畸形患者应早期进行手术。术中应完整切除海绵状血管畸形病灶（包括病灶周边的胶质瘢痕层和含铁血黄素层），同时行皮层热灼术

Surgical Treatment of Cerebral Cavernous Malformation Presenting Epileptic Seizures

Objective To provide effective surgical methods for patients with cavernous malformation complicated with epilepsy.Methods Twenty-seven patients with cavernous malformation complicated with epilepsy in our department were retrospectively analyzed. Simultaneously, we compared different epilepsy prognosis and other relevant factors between patients accepted total resection（including the gliotic and hemosiderin-stained brain tissue adjacent to the lesions） and patients accepted total resection combined with cortex thermocoagulation.Results ① Prognosis of patients treated with total resection combined with cortex thermocoagulation was much better than those who only accepted total resection（P=0.036）. ② Prognosis of patients whose course of epilepsy is less than 1 year was much better than those whose course is more than 1 year（P=0.022）. ③ There were no statistical significances for epilepsy prognosis in sex, age, the lobe where the cavernous malformation located, different epilepsy seizures, whether preoperative application of antiepileptic drugs（AEDs） and postoperative Karnofsky Performance Status Scale（KPS）.Conclusion The analysis of outcome showed that patients with cavernous malformation complicated with epilepsy benefited significantly from early surgery. And at the same time, in order to achieve better effect from the surgery, total resection of cavernous malformation（including the gliotic hemosiderin-stained brain tissue adjacent to the lesions） must be adopted, and cortex thermocoagulation treatment should be applied.