脑海绵状血管畸形相关性头痛临床特征及术后疼痛缓解的相关分析

Clinical characteristics of cerebral cavernous malformation related headache and analysis of pain resolution after surgical resection

目的探讨脑海绵状血管畸形(CCM)相关性头痛(CRH)的临床特点及其手术疗效、术后头痛缓解相关影响因素等。方法回顾性分析福建医科大学附属第一医院神经外科自2013年1月至2018年1月收治的43例单纯以头痛为首发症状的单发性CCM患者的临床资料。将患者按头痛程度进行分组,分为轻度头痛(14例)和中度头痛(29例);按治疗方式进行分组,分为手术组(27例)及保守组(16例);按远期头痛缓解程度分组,分为未缓解组(18例)和缓解组(25例),并对手术组再次分组,分为未缓解组(6例)和缓解组(21例)。对不同组别的相关资料进行单因素和多因素Logistic分析,并对比分析2组患者随访时的预后结局。结果本组CRH患者占所有CCM患者的23.5%。短期疗效:出院时手术组头痛缓解率为88.9%,较保守组(18.1%)明显提高,差异有统计学意义(P<0.05)。长期疗效:手术组头痛缓解率为77.8%,明显优于保守组(25.0%),差异有统计学意义(P<0.05)。其中手术治疗(OR=0.079,95%CI:0.015~0.417,P=0.003)是CRH远期缓解的独立保护因素;而病灶大小(CCM体积≥5 cm3)(OR=19.725,95%CI:1.701~228.779,P=0.017)是CRH患者术后远期缓解的独立危险因素。手术组随访时的不良事件发生率为29.6%,低于保守组(50.0%),但差异无统计学意义(P>0.05)。结论CRH是一种好发于中年CCM患者的继发性头痛,临床表现多为偏头痛型或紧张性头痛型。手术切除CCM病灶能长期、有效地缓解CRH,而当CCM病灶体积<5 cm3时进行外科手术切除,其远期疗效较好。

Objective To explore the clinical characteristics of cerebral cavernous malformation related headache(CRH),and to understand its surgical efficacy and related factors of postoperative headache relief.Methods The clinical data of 43 patients with single-form CCM admitted to Neurosurgery Department of the First Affiliated Hospital of Fujian Medical University from January 2013 to January 2018 were retrospectively analyzed.According to the degree of headache,the patients were divided into mild headache(14 cases)and moderate headache(29 cases);According to different treatment methods,the patients were divided into operation group(27 cases)and conservative group(16 cases);According to the degree of long-term headache relief,the patients were divided into non remission group(18 cases)and remission group(25 cases).The patients in the operation group were further divided into non remission group(6 cases)and remission group(21 cases).The related data of different groups were analyzed by univariate and multivariate logistic analysis.The prognosis of the two groups were compared and analyzed.Results CRH patients accounted for 23.5%of all CCM patients.Short-term efficacy:the headache relief rate of the operation group was 88.9%,which was significantly higher than that of the conservative group(18.1%)(P<0.05).Long-term efficacy:the headache relief rate of the operation group was 77.8%,which was significantly better than that of the conservative group(25.0%)(P<0.05).Surgical treatment(OR=0.079,95%CI:0.015-0.417,P=0.003)was an independent risk factor for long-term remission of CRH;The size of the lesion (CCM volume≥5 cm3) (OR=19.725,95%CI: 1.701-228.779,P=0.017) was an independent risk factor for long-term remission in patients with CRH. The incidence of adverse events in the operation group (29.6%) was lower than that in the conservative group (50.0%), but the difference was not statistically significant (P>0.05). Conclusion CRH is a kind of secondary headache in middle-aged patients with CCM. The main types of headache are migraine-like and tension headache. Surgical resection of CCM can effectively relieve CRH for a long time. When the volume of CCM lesion is less than 5 cm3, the long-term effect of surgical resection is good.