显微手术治疗隐匿性脑动静脉畸形并发癫痫

目的 :探讨隐匿性脑动静畸形 (AVM)并发癫痫的显微手术治疗。方法 :回顾性研究 36例隐匿性脑动静脉畸形并发癫痫的临床征象和手术方法。其中 2 5例病人采用显微手术 ,在皮质脑电图监测下 ,施行AVM病变加痫灶皮质切除术 19例 ,行AVM病变加部分痫灶皮质切除术 6例 ;余 11例仅行AVM病变切除术。综合分析两组病人术前术后癫痫发作和神经功能改善情况。结果 :2 5例行AVM病变加痫灶皮质切除术者 ,18例发作停止 ,占 72 0 % ,5例发作减轻 ,占 2 0 0 % ,2例无改善 ,占 8 0 % ;对照组仅行AVM病变切除术者 11例 ,其中 3例发作停止 ,占 2 7 3% ,3例发作减轻 ,占 2 7 3% ,5例无改善 ,占 4 5 4 %。经统计学处理两组间差异显著 (P<0 0 5 )。结论 :AVM病变加痫灶皮质切除是控制隐匿性脑动静脉畸形并发癫痫的有效方法。当受累皮质侵及重要功能脑域时 ,则宜行AVM病变加癫灶部分皮质切除术 ,以避免过多地损伤功能域皮质 ,加重神经废损。术中皮质脑电图对癫痫病灶彻底切除有指导作用。单纯病变切除因残留AVM病变附近的致痫灶 ,故不能有效地控制隐匿性脑动静脉畸形并发的癫痫发作。

Micro-surgery in the Treatment of Occult Cerebal Arteriovenous Malformati on Associated with Epilepsy

Objective:To discuss the efficacy of microsurgery in occ ult cerebral arteriovenous malformation(AVM)associated wit h seizures.Methods:The clinical features and operative ex perience of 36 patients were studied retrospectively.The electrocorticography(EcoG)were monitored during operation.Occult AVM lesionectomy and the epileptic focus removed were carried out in 25 patients and 11 pa tients had occult AVM lesionectomy only.The clinical features and final result were dissussed before and after operation.Results:A comparison between the two met hods revealed that patients having occult AVM lesionectomy plus epileptic focus removed showed their seizures were controled c ompletely in 72 0%,reduced in 20 0%,unchanging in 8 0%;otherwise,patients received occult AVM lesionectomy only,the seizures were controled completely in 27 3%,reduced in 27 3%,unchanging in 45 4%.The final results have significant difference statistically( P <0 05) Conc lusions:The method of occult AVM lesionectomy w ith additional corticectomy was more effective to control seizures postoperativelys,while t he occult AVM infiltrated the cerebral functional area was not suitable becau se it would result in more nearal deficit.The EcoG monitoring during operation was necessary to identify the epileptic focus.In carrying out occult AVM lesionectomy only was not effective to control the seizures associated with occult AVM.