手术与伽玛刀治疗对颅内海绵状血管瘤出血与癫痫的影响

Effect of surgical and gamma knife treatment on epilepsy and hemorrhage of intracranial cavernous malformation

目的评价手术与伽玛刀治疗对颅内海绵状血管瘤出血及癫痫的影响。方法回顾性分析68例手术及伽玛刀治疗的颅内海绵状血管瘤病例,通过CT、MRI检查及Engel分级评价两种方法治疗后出血、癫痫及放射性脑水肿情况。结果手术组术前共9例有癫痫病史,术后新发癫痫2例;伽玛刀治疗前12例有癫痫病史,术后新发癫痫3例;手术及伽玛刀治疗均能有效控制癫痫(P>0.05)。手术治疗后无再出血病例,伽玛刀治疗后2例发生再出血,两者相比无统计学差异(P>0.05)。手术组术后早期轻度脑水肿19例,中度脑水肿11例,严重脑水肿1例;伽玛刀治疗后中轻度18例,中度15例,重度5例;伽玛刀组局灶脑水肿明显多于手术组(P<0.05)。结论手术切除病灶依然是治疗颅内海绵状血管瘤的最佳方法,而对病灶位置深在或位于重要功能区者伽玛刀是一个重要的治疗手段,伽玛刀治疗的主要并发症是局灶性脑水肿,无明显诱发或加重癫痫和出血的风险,并且随着时间的延长,再出血机率将进一步降低。

Objective The study aims to evaluate the effect of surgical and gamma knife （GK） treatment on hemorrhage and epilepsy of intracranial cavernous malformation （CM）. Methods A total of 68 cases of intracranial CM treated by surgery or GK treatment were analyzed retrospectively and the hemorrhage, epilepsy, and radioactive cerebral edema after the treatments of two methods were evaluated by CT, MRI examination and Engel grading. Results Nine patients had epilepsy before surgery and the number increased to 11 after surgery. Twelve patients had epilepsy before surgery and the number increased to 15 after surgery. There was no significant difference between two treatments （P 〉0. 05）. No further hemorrhage case was observed after surgery; 2 cases occurred re-bleeding after GK; there was no significant difference between two treatments （P 〉0. 05）. In surgical group, mild cerebral edema occurred in 19 cases, moderate brain edema in 11 cases, and 1 case had severe brain edema after surgery; in GK group, mild edema occurred in 18 cases, moderate edema in 15 cases, and severe edema after GK in 5 cases. Edema in GK group was obviously more than that of surgical group （P 〈0.05）. Condusion The surgical resection remains the best treatment for intracranial CM. The GK treatment is an important means for lesions in a deep position or the important functional areas. The main complications of GK treatment is the focal cerebral edema with no obvious inducing or aggravating epilepsy and bleeding risk. As the extension of time, the probability of rebleeding will further reduce.