伴癫痫的颞叶海绵状血管瘤的手术治疗

发布时间：2018-03-16 20:33

  本文选题：海绵状血管瘤　切入点：癫痫　出处：《浙江大学》2015年博士论文　论文类型：学位论文

【摘要】：癫痫发作是幕上海绵状血管畸形患者最常见的症状,41%-80%的患者至少有过1次癫痫发作。对于已有癫痫发作的患者,再次出现发作的机率是每年5.5%。最新的研究认为对于从未发生过出血或神经功能障碍的海绵状血管畸形患者,一旦有过1次癫痫发作,其接下来5年中癫痫再发的机率高达94%。虽然目前海绵状血管畸形伴癫痫的最佳治疗方案并不明确,但很多医疗中心采用手术治疗的方法并取得良好效果。类似于其他的医疗中心,我科既往亦采用传统的的神经外科手术直接行病灶切除,但随访发现仍有不少比例的患者术后一直有癫痫发作,严重影响生活质量。自2012年末我院癫痫中心成立以来,更多伴癫痫的幕上海绵状血管畸形患者采用癫痫外科的评估和治疗。 目的 本研究目的在于明确对于伴癫痫的颞叶海绵状血管畸形患者,癫痫外科治疗是否优于传统的神经外科治疗。 方法 本研究中的患者分为两组,甲组和乙组的患者分别采用传统的神经外科手术和癫痫外科手术治疗。甲组：2008年3月到2012年12月共11例伴癫痫的颞叶海绵状血管瘤患者于浙江大学医学院附属第二医院神经外科行手术治疗,均至少随访2年；乙组：2012年9月到2014年4月共13例患者于我院癫痫中心行手术治疗,均随访至少1年。术后采用电话或门诊的形式随访。癫痫发作情况的评估采用Engel分级,术后神经功能的评估采用改良的Rankin量表。年龄、病灶大小应用t检验,其余因素如术前发作次数、病程、发作类型、病灶侧别、手术部位和术中脑电使用应用Fisher检验,P0.05认为有统计学差异。 结果 甲组和乙组术后1年的Engel Ⅰ级的患者比例分别为72.7%和100%。甲组患者术后随访25～81个月,平均42.5±17.5个月,Engel Ⅱ级7例(63.6%),其中Engel Ⅰa级6例(54.5%),Engel Ⅱ级2例(18.2%),Engel Ⅲ级和Ⅳ级各1例(9.1%)。最后随访时有3(27.3%)例在服用抗癫痫药物,均为单药治疗(表格2)。乙组随访12～27个月,平均15.9±4.2个月,13例患者均为Engel Ⅰ级(100%),其中Engel Ⅰa级12例(92.3%),另1例(7.7%)为Engel Ⅰc级,较甲组有显著性差异(P=0.009)。甲组11例术后mRS评分均为0分,一组13例患者中有7例评分为1分,均表现为轻度的记忆力下降。 结论 对于伴癫痫的颞叶海绵状血管瘤患者,传统神经外科预期能达到63.6%的长期癫痫无发作率,而癫痫外科预期能达到100%的长期癫痫无发作率。虽然本研究的患者例数尚少,且癫痫外科治疗的随访时间短,但初步结果显示对于伴癫痫的颞叶海绵状血管瘤患者,癫痫外科要优于传统神经外科。
[Abstract]:Seizure is the most common symptom in supratentorial cavernous vascular malformation. 41- 80% of the patients have at least one seizure. The chance of a relapse is 5.5 per year. New research suggests that in patients with cavernous vascular malformations that have never experienced bleeding or neurological dysfunction, once they have had an epileptic seizure, The risk of recurrent epilepsy in the next five years is as high as 94. Although the best treatment for cavernous vascular malformation with epilepsy is not clear, But many medical centers have adopted surgical treatment and achieved good results. Similar to other medical centers, our department has also used traditional neurosurgical operations to remove lesions directly. However, the follow-up showed that a large proportion of the patients still had seizures after operation, which seriously affected the quality of life. Since the establishment of the epilepsy center in our hospital in end of 2012, More patients with supratentorial cavernous vascular malformation with epilepsy were evaluated and treated by epilepsy surgery. Purpose. The aim of this study was to determine whether epilepsy surgery is superior to traditional neurosurgery in the treatment of cavernous temporal lobe malformation with epilepsy. Method. The patients in this study were divided into two groups. Patients in group A and group B were treated with traditional neurosurgery and epilepsy surgery respectively. Group A: 11 patients with temporal lobe cavernous hemangioma with epilepsy from March 2008 to December 2012 were attached to the School of Medicine of Zhejiang University. Neurosurgery is performed in the second Hospital, All patients were followed up for at least 2 years, group B: from September 2012 to April 2014, 13 patients underwent surgical treatment in our epilepsy center, all of them were followed up for at least one year. All patients were followed up by telephone or outpatient service after operation. The epileptic seizures were assessed by Engel grade. The postoperative neurological function was evaluated by modified Rankin scale. Age and lesion size were measured by t test. Other factors such as preoperation attack frequency, course of disease, attack type, side of lesion, other factors, The site of operation and the use of intraoperative EEG were statistically different with Fisher test (P0.05). Results. The proportion of Engel grade 鈪，

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