成人烟雾病联合血管重建术后癫痫发作特点及危险因素分析

Analysis of risk factors for epileptic seizure after combined revascularization in adult patients with moyamoya disease

目的 总结烟雾病联合血管重建术后癫痫发作的临床特点并筛查相关影响因素。方法纳入云南省第一人民医院2015年1月至2021年6月收治的189例成人烟雾病联合血管重建术后患者,单因素和多因素前进法Logistic回归分析筛查联合血管重建术后癫痫发作的影响因素。结果 Logistic回归分析显示,术前有癫痫发作史(OR=5.523,95%CI:1.486~20.524;P=0.011)、桥血管位于额叶(OR=2.793,95%CI:1.027~7.597;P=0.044),以及术后并发脑梗死(OR=9.025,95%CI:2.121~38.404;P=0.003)、脑过度灌注综合征(OR=3.624,95%CI:1.281~10.253;P=0.015)和脑出血(OR=5.646,95%CI:1.219~26.142;P=0.027)是烟雾病患者术后癫痫发作的危险因素。结论 术前有癫痫发作史、联合血管重建术桥血管位于额叶,以及术后并发脑梗死、脑过度灌注综合征和脑出血是成人烟雾病患者术后癫痫发作的危险因素,及时对危险因素进行干预,有可能减少术后癫痫发作。

ObjectiveTo summarize the clinical features of postoperative epileptic seizure inadults with moyamoya disease(MMD) treated with combined revascularization,and screen the relatedinfluencing factors.MethodsTotal 189 patients with MMD who underwent combined revascularization inDepartment of Neurosurgery of the First People’s Hospital of Yunnan Province from January 2015 to June2021 were included.Univariate and multivariate forward Logistic regression analysis was used to screen theinfluencing factors of epilepsy after combined revascularization in MMD patients.ResultsLogisticregression analysis showed preoperative seizure(OR = 5.523,95%CI:1.486-20.524;P = 0.011),revascularization bypass vessel located in frontal lobe(OR = 2.793,95%CI:1.027-7.597;P = 0.044),postoperative cerebral infarction(OR = 9.025,95%CI:2.121-38.404;P = 0.003),cerebral hyperperfusionsyndrome(OR = 3.624,95%CI:1.281-10.253;P = 0.015) and intracranial hemorrhage(OR = 5.646,95%CI:1.219-26.142;P = 0.027) were the risk factors of postoperative epileptic seizure in patients with MMD.ConclusionsPreoperative seizure,revascularization bypass vessel located in frontal lobe,postoperativecerebral infarction,cerebral hyperperfusion syndrome and intracranial hemorrhage are the clinical riskfactors of epileptic seizure in adult MMD patients,timely intervention of risk factors may reducepostoperative epileptic seizure in patients with MMD.