摘要
目的探讨伴有癫痫病史的幕上脑海绵状血管瘤(CA)的手术策略。方法回顾性分析57例伴有癫痫病史的幕上脑海绵状血管瘤患者的资料,依据癫痫发作情况将其分为顽固组(41例)和偶发(或初发)组(16例)。顽固组内行单纯病变切除者15例,行病变切除及致痫灶扩展切除者26例。分别分析其病灶部位、临床表现、切除范围与术后随访结果。结果57例患者均行显微手术治疗,40例部位深在,均运用导航指引术中定位。本组无远期神经功能障碍,术后癫痫控制EngleⅠ级45例(81.8%),EngleⅡ级4例(7.3%),EngleⅢ级4例(7.3%),EngleⅣ级2例(3.6%)。结论①幕上脑海绵状血管瘤伴发癫痫的患者应尽早行手术治疗。②对于初发或偶发癫痫患者,手术切除病变及周围含铁血黄素沉积带即可获得满意的癫痫控制;对于顽固性癫痫患者,在前者基础上加行致痫皮层切除或脑叶切除将获得更理想的效果。③脑磁图检查结合EEG对术前癫痫灶定位有较大帮助。
Objective The aim of this study is to explore the surgical strategy of supratentorial cavernous angiomas associated with epilepsy.Methods We analyze retrospectively the profiles of 57 patients who harbored supratentorial cavernous angiomas accompanying epilepsy.The patients were classified into the intractable epilepsy group(n=41) and the sporadic(or incipient) seizure group(n=16).In the intractable epilepsy group,15 patients were treated by pure lesionectomy,while other 26 were treated by lesionectomy as well as by extended epileptic zone resect.The locations of lesions,manifestation,excision ranges and the outcomes of postoperative follow-up were analyzed respectively.Results All of the 57 patients were treated by microsurgery,of which 40 operations of deep lesions were guided by neuronavigation.There was no neurological deficit in study of long-term follow-ups.Outcomes of seizure control are as follows: 45(81.8%) Engle classⅠ,4(7.3%) Engle class Ⅱ,4(7.3%) Engle class Ⅲ,2(3.6%) Engle class Ⅳ.Conclusion ①Patients with epilepsy caused by supratentorial cavernous angiomas should be treated as early as possible.② As for patients with sporadic or incipient seizure,the resecting of lesion and surrounding hemosiderin rim is adequate for satisfactory seizure control whereas for those with intractable epilepsy,an extra excision of epileptic cortical or lobe is needed to achieve better effect.③ Magnetoencephalography and EEG used together contribute a lot to the location of epileptic focus.
出处
《立体定向和功能性神经外科杂志》
2010年第1期20-22,共3页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
海绵状血管瘤
癫痫
外科
脑磁图
神经导航
Cavernous angiomas
Epilepsy
Surgery
Megnetoencephalography
Neuronavigation