脑膜瘤术后癫痫发生的危险因素分析

目的分析脑膜瘤手术后癫痫发生的危险因素。方法回顾性分析行手术治疗且资料完整的158例脑膜瘤病人的临床资料，以性别、年龄、主要症状、术前癫痫史、阳性体征、肿瘤部位、手术操作时间、皮质牵拉伤、动静脉损伤、术后血肿、颅内感染、术后水肿、肿瘤切除程度、手术次数、放射治疗、肿瘤复发等16项可能影响因素为自变量，以术后发生癫痫为因变量，使用Logistic回归分析研究相关的危险因素。结果术前癫痫史、肿瘤部位、术后水肿、肿瘤切除程度、肿瘤复发等5个因素为脑膜瘤术后癫痫发生的危险因素。结论脑膜瘤术后癫痫的发生影响病人生活质量，防治癫痫发生的危险因素，有望减少脑膜瘤术后癫痫的发生，改善预后。     

脑膜瘤术后癫(癎)发生的危险因素分析

目的分析脑膜瘤手术后癫疒间发生的危险因素。方法回顾性分析行手术治疗且资料完整的158例脑膜瘤病人的临床资料,以性别、年龄、主要症状、术前癫疒间史、阳性体征、肿瘤部位、手术操作时间、皮质牵拉伤、动静脉损伤、术后血肿、颅内感染、术后水肿、肿瘤切除程度、手术次数、放射治疗、肿瘤复发等16项可能影响因素为自变量,以术后发生癫间疒为因变量,使用Logistic回归分析研究相关的危险因素。结果术前癫间疒史、肿瘤部位、术后水肿、肿瘤切除程度、肿瘤复发等5个因素为脑膜瘤术后癫疒间发生的危险因素。结论脑膜瘤术后癫疒间的发生影响病人生活质量,防治癫疒间发生的危险因素,有望减少脑膜瘤术后癫疒间的发生,改善预后。     

脑胶质瘤术后早期癫痫发作的危险因素分析

目的探讨脑胶质瘤术后早期癫痫发作的危险因素。方法选取我院手术治疗的脑胶质瘤患者173例,根据术后是否发生早期癫痫分为观察组与对照组,探讨其术后早期癫痫发作的相关危险因素。结果与脑胶质瘤术后早期癫痫发作相关的因素有术前癫痫史、病理级别、肿瘤位置、肿瘤大小及瘤周水肿(P0.05)。术前无癫痫史者,术后早期癫痫发作风险降低,OR和95%CI分别为0.198与0.096~0.410。病理级别越高者,术后早期癫痫发作风险越低,OR和95%CI分别为0.695与0.529~0.911。位于额颞叶的肿瘤,术后早期癫痫发作风险高,OR和95%CI分别为0.833与0.701~0.991。肿瘤越大、瘤周水肿带越宽者,术后早期癫痫发作风险越高,OR分别为2.552、2.048。结论临床应针对上述危险因素,采取有效干预措施,降低术后早期癫痫的发生率,改善预后,提高患者生活质量。     

幕上胶质瘤术后早期癫痫发作危险因素分析

目的探讨胶质瘤术后早期癫痫发作的危险因素。方法对2010年1月～2011年12月我院接受开颅手术的256例胶质瘤临床资料进行单因素及多因素Logistic回归分析。结果术后早期癫痫发作的患者16例,发生率为6.25%,其中部分性发作7例(43.75%),全身强直阵挛性发作9例(56.25%),癫痫持续状态1例(6.25%)。单因素分析显示,术前癫痫史、肿瘤位置、术后是否水肿明显及瘤腔是否有出血与胶质瘤术后早期癫痫发作相关(P<0.05),进一步多因素Logistic回归分析,结果显示仅术前癫痫史、肿瘤位置及瘤腔是否出血为危险因素,其OR值分别为4.339、3.073、2.771。结论术前癫痫史、肿瘤位置及瘤腔是否出血是幕上胶质瘤术后早期癫痫的发生的危险因素。     

脑膜瘤术后复发的相关因素分析

目的 探讨脑膜瘤术后复发的相关因素.方法 回顾性研究405例颅内脑膜瘤,对其临床资料进行统计学分析,寻找复发的相关因素.结果 37例脑膜瘤术后复发,其特点表现为患者年轻、术前存在癫痫、肿瘤基底位于矢状窦旁及鞍结节、蝶骨嵴、颅眶沟通等颅底部位、体积大、不规则形、瘤周水肿明显或瘤内存在低密度、手术切除程度低或病理级别高.结论 脑膜瘤术后复发的相关因素包括年龄、术前癫痫、肿瘤部位、最大径、形状、瘤周水肿、病理类型以及手术切除程度等.     

脑动静脉畸形术后癫(癎)发生的危险因素分析

目的 探讨脑动静脉畸形(AVM)术后癫(癎)发生的危险因素.方法 回顾性分析接受手术并有完整临床资料的脑动静脉畸形病例138例,以性别、年龄、主要症状、阳性体征、术前癫(癎)史、病变部位、畸形团大小、引流静脉、手术入路、术后水肿、病灶残留、手术次数、癫(癎)灶切除等13项可能的影响因素为自变量,设定术后发生癫(癎)为因变量,使用Logistic逐步回归分析研究相关的影响因素.结果 术前癫(癎)史、病变部位、畸形团大小、引流静脉、术后水肿等5个因素是术后癫(癎)发生的危险因素.结论 对脑动静脉畸形手术病人,应针对癫(癎)发生危险因素进行防治,以减少脑动静脉畸形术后癫(癎)的发生.     

复发难治部位恶性胶质瘤的手术及治疗策略

研究背景复发恶性胶质瘤由于肿瘤浸润而侵犯重要神经或脑深层结构,进一步增加再次手术和治疗的难度。因此,如何制定合理的治疗策略,在最大限度切除肿瘤的同时保证患者基本生存质量,是目前争论的热点。本文旨在探讨复发恶性胶质瘤的合理治疗方式和最佳手术策略。方法对4例典型复发恶性胶质瘤患者术前影像、术中操作、术后并发症,以及远期随访结果进行综合评价,阐述对其治疗策略。结果其中2例术后MRI检查显示复发肿瘤位于T2WI少量水肿残余部位;1例根据T2WI所示于术中行水肿带扩大切除,术后近期出现感觉性失语和右侧肢体乏力,经改善脑循环、高压氧,辅助针灸及物理康复训练症状明显改善;1例脑干胶质瘤采取激光刀精确"雕刻式"手术切除,术后未出现明显神经功能障碍表现,恢复良好。4例患者术后均接受替莫唑胺(200mg/kg,5d/28d)化疗,平均随访(14.00±12.50)个月。结论对于明显复发的恶性胶质瘤患者,再次手术仍是延长生存时间的关键,扩大切除T2WI所示水肿带能减少肿瘤复发机会。在保持患者术后基本生存质量(Karnofsky生活质量评分>70分)基础上,应采用病灶扩大全切除;而针对毗邻脑功能区的肿瘤病灶,则应采取精确"雕刻式"切除,尽量减少肿瘤细胞残留。     

复发脑胶质瘤再手术后颅内感染的影响因素及病原学分析

目的研究复发脑胶质瘤患者再次手术治疗,术后发生颅内感染的影响因素及病原学特点。方法回顾性收集手术治疗的复发脑胶质瘤82例,探讨术后颅内感染情况及影响因素,进行分析。同时收集同期行手术治疗的原发脑胶质瘤病例200例进行统计分析。采用χ~2检验进行单因素比较分析,二分类Logistic回归分析用于探讨复发性胶质瘤再次手术发生颅内感染的独立危险因素。结果复发脑胶质瘤组和原发脑胶质瘤组患者中分别有36例(43.90%)和12例(6.00%)发生颅内感染,且差异有统计学意义(P0.05)。原发胶质瘤患者中年龄≥55岁、合并糖尿病、其他恶性肿瘤史、III-IV级病理分级、术前合并放化疗、术中脑室系统打开患者所占的比例显著低于复发胶质瘤患者(P0.05)。年龄、术前合并糖尿病、术中打开脑室系统、手术时间≥4小时与复发性胶质瘤患者术后发生较高的颅内感染率有关(P0.05)。36例复发胶质瘤颅内感染患者的脑脊液标本中共分离出25株病原菌,其中革兰氏阳性菌居多,占56.00%。多因素分析结果显示:相对于年龄55岁者,年龄≥55岁的复发胶质瘤患者术后发生颅内感染风险的OR值为14.783(95%CI=1.011～216.058)。结论复发胶质瘤患者术后发生颅内感染的概率远大于原发胶质瘤患者。年龄、术前合并糖尿病、术中打开脑室系统、手术时间4小时与复发性胶质瘤患者术后颅内感染率较高有关。年龄是复发胶质瘤患者术后发生颅内感染的独立危险因素。     

仅有癫痫表现的幕上胶质细胞瘤65例手术疗效

目的探讨仅有继发性癫痫表现的幕上胶质瘤的手术疗效及其影响因素.方法对经手术治疗、仅有继发性癫痫表现的65例幕上胶质瘤患者进行回顾性分析,探讨性别、年龄、术前癫痫病程、癫痫发作类型、肿瘤部位、手术切除程度等对癫痫预后的影响.结果本组男性34例,女性31例,平均年龄35.3岁,首次发作癫痫的平均年龄31.5岁,术前癫痫病史平均36.4个月.56例( 86.2% )为高分化型(low-grade)胶质瘤,9例(13.8%)为低分化型(high-grade)胶质瘤.开颅脑肿瘤切除术后神经系统并发症发生率为20.3%.术后癫痫控制有效率为66.2%.性别、年龄和术前癫痫病程与癫痫预后无关.部分性发作者癫痫预后较全身性发作者好( P <0.05).额叶和顶叶肿瘤术后神经系统并发症发生率较颞叶肿瘤高( P <0.05),而颞叶肿瘤术后癫痫控制效果较额叶和顶叶肿瘤好( P <0.05).肿瘤全切除和次全切除者的癫痫控制效果比部分切除和单纯活检病例的癫痫控制效果显著好( P <0.001).该组患者经综合治疗后预后较好,长期生存率高.结论仅有继发性癫痫表现的幕上胶质瘤多为高分化型,是胶质瘤中预后相对较好的特殊类型,癫痫发作类型、肿瘤部位和手术切除程度具有预后价值.     

影响胶质母细胞瘤患者预后的多因素分析

目的 探讨影响胶质母细胞瘤患者预后的临床因素.方法 回顾2008年1月至2013年1月于南方医科大学南方医院行显微手术治疗的198例原发胶质母细胞瘤患者的临床资料,对性别、年龄、起病至就诊时间、术前有无癫痫发作、术前KPS评分、肿瘤部位、肿瘤直径、肿瘤是否发生囊变、手术切除程度、术后是否行同步放化疗、术后是否存在颅内感染共11项因素进行生存分析.结果 单因素分析结果示术前有无癫痫发作、肿瘤部位、术前KPS评分、手术切除程度、术后是否同步放化疗、术后是否存在颅内感染对胶质母细胞瘤患者的预后有影响(P＜0.05);多因素分析结果示手术切除程度、肿瘤部位、术前KPS评分、术后是否同步放化疗、术后是否颅内感染具有统计学意义(P＜0.05).结论 手术切除程度、肿瘤部位、术前KPS评分、术后同步放化疗是影响胶质母细胞瘤患者的主要预后因素,其中手术切除程度是最重要的预后因素;而术后颅内感染的患者生存时间延长,可能与感染诱导的肿瘤免疫有关.     

Quality of life of patients after epilepsy surgery]

Drug resistant epilepsy impairs patients' quality of life making social interaction more difficult. Surgical treatment is an option for seizure control in medically refractory patients. We evaluated pre-operative and post-operative quality of life using a standardized questionnaire based on the QOLIE-10. The questionnaire included ten questions dealing with psychosocial and drug's side effects and was applied before surgery and eight months post-operatively. The studied sample comprised twelve consecutive adult patients with epilepsy treated surgically who were seizure free. Differences were found between the pre-operative and post-operative periods in 70% of the questions, with a better post-operative profile. Successful epilepsy surgery has a great impact in the quality of life of these patients.     

Post-operative hematoma after surgery for intracranial meningiomas: causes, avoidable risk factors and clinical outcome

Intracranial meningiomas are mainly benign lesions amenable for surgical resection. However, removal of an intracranial meningioma carries a higher risk of post-operative hemorrhage compared to surgery for other intracranial neoplasms. Because avoidance of post-operative hematoma is of vital interest for neurosurgical patients, the aim of this retrospective study was to analyze risk factors of post-operative hematoma associated with meningioma surgery. Two hundred and ninety six patients with intracranial meningiomas, operated between June 1998 and June 2002, were included in this study. Patients who developed a space-occupying post-operative intracranial hemorrhage and were treated surgically were identified. Data of patients with and without hematoma were retrospectively analyzed to identify risk factors associated with post-operative hematoma. Variables analyzed included patients' age, invasion of venous sinus by the meningioma, tumor vascularization, arachnoidal infiltration, pre-operative prophylaxis of thromboembolic events, peri-operative coagulation abnormalities, residual tumor, location and histology of the tumor. Outcome of patients with post-operative hematoma was assessed according to the Glasgow Outcome Scale (GOS) at discharge and at three months. 21 patients (7.1 %) of 296 patients developed a post-operative intracranial hematoma requiring surgical evacuation. Age was significantly higher in the hematoma group 62.4 +/- 14.0 years compared to patients without post-operative hematoma 56.1 +/- 12.0 (p < 0.05; t-test). Patients older than 70 years had a six-fold increased risk to develop a post-operative hematoma (Chi2 test, 95% CI 1.949-13.224). Patients with post-operative hemorrhage had significant lower post-operative prothrombin time, fibrinogen and platelets immediately after surgery and lower platelets at day 1. None of the other parameters, including pre-operative routine coagulation values, differed significantly between patients with and without post-operative hemorrhage. Three patients with post-operative hematoma showed platelet dysfunction and three patients showed decreased FXIII activity. Of those patients with post-operative hemorrhage at three months follow up three patients (13%) succumbed from reasons not directly related to hemorrhage, one patient remained GOS 2 (4.3%), four patients (17.4%) were GOS 3 and 15 (65.4%) patients had favorable outcome (GOS 4 [one patient] and GOS5 [14 patients]). Meningioma surgery carries a higher risk for post-operative hematoma in the elderly. Thrombocytopenia and other hemostatic disorders were frequently associated with post-operative hemorrhage after meningioma surgery, while no surgical factors could be defined. Extending coagulation tests and specific replacement therapy may prevent hematoma formation and improve the patients outcome.     

胶质瘤相关性癫痫术后疗效及影响因素分析

目的探讨胶质瘤相关性癫痫患者术后恢复情况,以及痫性再次发作的危险因素。方法收集89例胶质瘤相关性癫痫患者的一般资料。所有患者行肿瘤及致痫灶切除术,记录患者术后1周,术后1个月,术后3个月,术后6个月的Engle分级评分,其差别行组内重复测量资料的方差分析,应用Kaplan—Meier法制作痫性再发风险曲线,并对癫痫再次发作相关因素行Cox回归模型分析。结果术后癫痫再发率为26.97%(24/89),术后1周Engle分级评分为2.966±0.081,术后1月为2.202±0.080,术后3月为1.730±0.093,术后6月为1.313±0.042,差异存在统计学意义(F_(时间)=96.076,P0.01);Cox回归模型显示,肿瘤累及部位(RR=2.908,CI:1.083~7.806),术后水肿形成(RR=4.769,CI:1.737~13.096)以及肿瘤复发(RR=8.309,CI:3.379~20.432)是癫痫再次发作的重要危险因素(均P0.05)。结论术后患者的癫痫发作减少甚至消除,长期疗效优于短期疗效,对癫痫再次发作相关因素应尽早处理,有利于提高患者预后的生存质量。     

幕上胶质瘤致癫相关因素分析

目的探讨幕上胶质瘤致癫相关因素。方法回顾性分析175例幕上胶质瘤病人的临床资料,其中伴发癫51例(29.1%);并对肿瘤部位、影像学特点、侵犯皮质及病理类型等致癫相关因素进行统计分析。结果额叶胶质瘤癫发生率明显高于其他部位胶质瘤(P0.01),少枝胶质细胞瘤及低级别星形细胞瘤易于发生癫(P0.017),肿瘤侵犯皮质病人癫发生率明显高于未侵犯皮质者(P=0.01)。结论幕上胶质瘤伴发癫与肿瘤所在部位、病理类型及侵犯皮质相关。对于此类病人不仅需手术切除肿瘤,还应控制癫发作,减少并发症,提高生存质量。     

Risk factors for carbamazepine elevation and toxicity following epilepsy surgery.

SUMMARY: A proportion of patients undergoing epilepsy surgery, and receiving carbamazepine (CBZ), experience significant elevations in CBZ plasma concentrations, some with associated CBZ toxicity. The objective of this study was to identify significant risk factors for elevations (>12 microg/ml) in CBZ concentrations and CBZ-induced toxicity following epilepsy surgery. METHODS: We retrospectively examined charts of 74 inpatients (31 children and 43 adults) chronically receiving CBZ and undergoing epilepsy surgery between January 1996 and June 2000. Patient demographics, medications, type of surgery, seizure history, adverse events, CBZ doses and concentrations were evaluated. RESULTS: 51.2% of adults and 51.6% of pediatric patients had drug elevations. In the pediatric group, 12.9% had symptoms of toxicity compared to 9.3% in the adult group. Five risk factors-pre-operative CBZ dose, fentanyl dose, surgery day CBZ concentration, body weight, and blood loss-were related to post-operative CBZ concentrations. Three risk factors: age <18 years, pre-operative CBZ dose, and the surgery day CBZ (immediate pre-operative) concentration, were significantly related to the outcome measure of abnormal CBZ concentration (>12 microg/ml). Two variables significantly related to toxicity were average post-operative CBZ dose and the surgery day CBZ concentration. Increases in concentrations occurred at a mean 33+/-13.7 h (range: 11-74 h) after surgery. DISCUSSION: Based upon our results in patients with one or more risk factors, we suggest that reduction of post-operative CBZ doses be considered.     

癫痫诊疗中应用头皮脑电图偶极子定位的体会

目的总结癫痫诊疗中应用头皮脑电图偶极子定位在术前、术中、术后的意义。方法回顾性分析29例行偶极子源成像定位癫痫灶、17例进行手术治疗,术中与皮层脑电图、深部电极记录对比,参考手术治疗效果。结果术后随访无癫痫发作或偶有先兆发作12例,发作形式改变（术前大发作变为小发作）和发作次数减少75％以上3例,发作次数减少不到50％1例,无变化1例,手术总有效率为94％。结论头皮EEG偶极子的术前定位方法无创、准确,可避免创伤性检查用于癫痫病人的术前定位。     

合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素分析

目的探讨合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素。方法回顾性分析2015年6月至2019年1月手术治疗的80例合并癫痫的幕上低级别胶质瘤的临床资料。术后1年,采用Engel分级评估癫痫预后,Ⅰ级为预后良好,Ⅱ~Ⅳ级为预后不良。用多因素logistic回归分析检验影响癫痫预后的影响因素;受试者工作特征(ROC)曲线分析术前癫痫发作频率预测癫痫预后的价值。结果80例中,术后癫痫预后良好59例,预后不良21例。多因素logistic回归分析结果显示,异柠檬酸脱氢酶(IDH)1突变和术前癫痫发作频率高是胶质瘤病人术后癫痫的独立危险因素(P<0.05),全切肿瘤和术后化疗是保护性因素(P<0.05)。术前癫痫发作频率预测癫痫预后的ROC曲线下面积为0.805(95%置信区间0.685~0.914;P<0.05);当术前癫痫发作频率≥2次/月时,预测术后癫痫预后不良的灵敏度和特异度分别为92.86%和46.85%。结论IDH1突变和术前癫痫发作频率高是合并癫痫的幕上低级别胶质瘤病人癫痫预后不良的危险因素,而肿瘤全切除和术后化疗明显改善癫痫预后。     

垂体泌乳素微腺瘤经蝶显微手术后复发的相关因素分析

目的分析垂体泌乳素微腺瘤(MIP)经蝶显微手术后的复发情况及其相关因素。方法对经蝶显微手术诊治的68例MIP患者的临床和随访资料进行卡方检验和Logistic回归分析,以病程、术前是否服用溴隐亭,是否侵及硬膜,肿瘤质地,术前泌乳素(PRL)水平,术后初始PRL水平为变量。结果术前PRL水平,术后初始PRL水平与复发显著相关(P<0.05),且其与复发成正相关,其中术后初始PRL水平是复发最重要的影响因素。其它因素如病程,术前是否服用溴隐亭,硬膜侵袭性和肿瘤质地与复发无明显相关性(P>0.05)。结论垂体MIP术后复发相关的因素主要有术前PRL水平和术后初始PRL水平,其中术后初始PRL水平对复发具有重要的预测意义。     

The impact of pre-operative symptoms on carotid endarterectomy Outcomes: Analysis of the ACS-NSQIP carotid endarterectomy database

Carotid artery stenosis accounts for up to 20% of ischemic strokes. Since the 1950 s, one of the primary surgical treatment for this condition is carotid endarterectomy (CEA). Because of improvement of medical therapy for carotid artery atherosclerosis and the increased use of carotid artery stents, CEA is indicated if the risk of stroke and death are low. The goal of this study is to characterize the impact of pre-operative stroke and stroke risk factors on post-operative CEA patient outcomes, using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Vascular Module on CEA. Using the Targeted Vascular Module of the ACS-NSQIP, 22,116 patients who underwent CEA were identified from 2011 to 2016. Univariate analysis and multivariable logistic regression analyses were conducted to identify significant risk factors that predispose patients to stroke. Patients with pre-operative stroke comprise 42.1% of the group, with post-operative stroke being the second most common complication (2.1%). Pre-operative stroke patients were also at a higher risk for transient ischemic attacks, post-operative restenosis, post-operative distal embolization, and other complications. Patients with pre-operative risk factors, including stroke or stroke-like symptoms, high risk physiologic factors, high risk anatomic factors, and contralateral internal carotid artery stenosis were at a higher risk of developing post-operative stroke and other complications. Patients with these pre-operative risk factors should be closely monitored for post-operative complications in an effort to improve patient outcomes.