幕上海绵状血管瘤伴顽固性癫痫的手术治疗

目的 探讨幕上海绵状血管瘤伴顽同性癫痫的临床特点及手术治疗策略.方法 2000至2008年手术治疗14例幕上脑内海绵状血管瘤患者,术前均行头部MRI检杏,均以顽固性癫痫为主要症状,术后经病理证实并长期随访.结果 所有患者采用多种抗癫痫药物治疗,效果不佳,手术根据病灶数目、位置及与功能区的关系可一期直接完成或分期完成.术后配合药物治疗,经长期随访,癫痫控制良好,无手术导致的功能障碍.结论 MRI诊断海绵状血管瘤有较高的特异性与敏感性,典型表现为T2WI图像上病灶周围有环形低信号区.幕上海绵状血管瘤伴顽固性癫痫的患者应积极手术,且效果较好.具体可根据病灶位置、脑电图表现及临床症状借助颅内电极、立体定向技术制定针对性手术方案.

Surgical strategy of supratentorial cavernous angioma associated with refractory epilepsy

Objective To characterise the clinical freatures and surgery strategy of supratentorial cavernous angioma associated with refractory epilepsy.Methods Between June 2000 and July 2008,14 patients suffering from supratentorial cavernous angioma associated with refractory epilepsy all received head MRI and underwent surgery in Beijing Xuanwu Hospital.The diagnosis were pathologically confirmed The surgical results were followed up.Results All the patients tried varied antiepileptic drugs but the results were poor.The operation were completed once or staged,according to the number of lesions,location,and the relation with brain functional area.Most patients did not have any more seizures in the postoperative period,no neurologic deficits were found.Conclusions MRI is more sensible and specific in detecting cavernous angioma,a low signal intensity around the lesions is usually showed on T2WI.Neurosurgical resection should be recommended for the patients with supratentorial cavemous angiorna associated with refractory epilepsy and often gives excellent results.The surgical procedure should be planned carefully regarding to the lesion(s) location,EEG and symptoms,sometime by combing frame-stereotactic localization and functional mapping.