手术切除海绵状血管畸形对控制癫痫症状的研究

Effects of exairesis for carernous malformations on symptoms of seizure

目的探讨神经导航切除脑内海绵状血管畸形(cavernousmalformations,CMs)、术中脑皮层电图监测多处皮层热灼癫痫灶,对CMs引起的难治性癫痫的治疗效果。方法回顾性分析1998年10月至2004年10月收治的29例CMs患者的临床资料,男25例,女4例;年龄13～62岁,平均32.9岁。均以癫痫为首发症状,且药物难以控制。全身发作22例,部分发作7例。癫痫病程:平均71.1个月。病灶部位:多发4例,顶部2例,额部7例,颞部11例,枕部5例;病灶直径:10～50mm,平均直径17.6mm。手术在导航指引下开颅,确定病变部位,经皮层的脑沟和脑裂入路,显微镜下分离完全切除病灶。术中脑皮层电图监测,皮层热灼术消除癫痫波。术后服用抗癫痫药2～6个月。结果29例术后复查CT/MR均未见残留。本组无手术死亡,术后一过性神经功能障碍1例。对24例随访6～77个月(平均29.5个月),其中19例(79.2%)无发作,5例(20.8%)癫痫明显改善,短期再次服药后无癫痫发作。癫痫控制率达100%。结论在神经导航引导下利用脑沟等自然间隙入路,手术切除脑内CMs,术中脑皮层电图监测,采用多处皮层热灼术消除癫痫波,治疗CMs及其引起的癫痫包括难治性癫痫效果较好。

Objective To analyze effects of exairesis for carernous malformations on symptoms of seizure under the guidance of neuronavigation and monitoring of ECOG. Methods Twenty-nine patients with CMs from 1998 to 2004 were admitted to our hospital. There were 25 male and 4 female; age of patients ranged from 13 to 62 years with the average of 32.9 years. The initial symptom was seizure, which was intractable. The loci were seperated and resected under a microscope through the approach of cerebral sulci and fissures, which were monitored by ECOG. Bipolar electrocautery on the functional cortex was performed to eliminate epileptic waves. Anti-epileptic drugs were used for two to six months after the resection of loci. Results All of the lesions were resected totally, and no residual of loci was found by post-operational CT/MR examination. There was no patient died of operation. One patient had transitory neurological dysfunction after operation and recovered in one mouth. Twenty four patients were followed up for 6-77 months with mean time of 29.5 months. There were 19 patients who haven＇t seizure again and 5 patients with improved symptoms. Conclusions Under the guidance of neuronavigation and monitoring of ECOG, the loci of CMs were resected under a microscope through the approach of cerebral sulci and fissures, and bipolar electrocautery on the functional cortex was performed to eliminate epileptic waves. It is effective for the patients of intractable epilepsy.