目的探讨颅脑结构性病变所致癫痫的伽玛刀(γ-刀)治疗方法,评价治疗效果及视频脑电图(VEEG)随访的意义。方法回顾性分析山东省戴庄医院伽玛刀治疗科和神经科2017-01—2021-06确诊的60例颅脑结构性病变所致癫痫患者的临床资料,根据是否...目的探讨颅脑结构性病变所致癫痫的伽玛刀(γ-刀)治疗方法,评价治疗效果及视频脑电图(VEEG)随访的意义。方法回顾性分析山东省戴庄医院伽玛刀治疗科和神经科2017-01—2021-06确诊的60例颅脑结构性病变所致癫痫患者的临床资料,根据是否采用γ-刀治疗将其分为单纯药物治疗组(对照组)和γ-刀联合药物治疗组(γ-刀组),每组30例,进行随访观察,分析γ-刀治疗的效果及随访VEEG检测结果。结果在1~2 a的随访期内,γ-刀组患者癫痫总改善率76.67%,对照组为36.67%,差异有统计学意义(P<0.05);γ-刀组EEG痫样放电检出率30.00%,对照组为66.67%;γ-刀组癫痫控制显效组EEG正常率为50%,明显高于有效组的11.11%及无效组的0,显效组EEG痫样波检出率(7.14%)明显低于有效组(22.22%)和无效组(85.71%)。γ-刀治疗后随访期内癫痫发作改善率分别为0.5~1 a 63.33%,>1~2 a 76.67%,>2~3 a 80.77%,3 a以上82.61%;VEEG痫样波检出率分别为0.5~1 a63.33%,>1~2 a 30.00%,>2~3 a 23.08%,3 a以上21.74%。术后并发放射性脑水肿3例(10.00%)。结论γ-刀治疗颅内结构性病变所致的难治性癫痫效果明确,VEEG有助于γ-刀治疗方案的设计、评估治疗效果和指导治疗后用药。展开更多
Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors. Most CPA tumors are benign, but can cause nerve damage or compress the surrounding structures if left untreated. The typical prese...Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors. Most CPA tumors are benign, but can cause nerve damage or compress the surrounding structures if left untreated. The typical presentation is with adult-onset sensorineural hearing loss or non-pulsatile tinnitus. In some patients, this goes unnoticed, and presentation is delayed until the lesion is much larger and presents with symptoms related to mass effect. We present the case study of 63 years old gentleman, who had suspected left CPA lesion on CT head done few years ago for dizziness and left-sided facial numbness. MRI could not be done at that time due to his MRI incompatible pacemaker leading to delay in his management eventually causing loss of patient to the follow up. He later developed progressive difficulty in walking which was initially attributed to as secondary to vasovagal syncope and postural hypotension. He eventually presented to us with intractable nausea and vomiting, worsening headache and ataxia. He had an urgent CT head which showed significant growth in the lesion with compression of the surrounding structures and obstructive hydrocephalus. He was given steroids which improved his nausea and vomiting, followed by undergoing surgery in regional center leading to significant improvement in his gait within few days of surgery. He unfortunately continued to have a degree of ataxia and facial numbness. This case illustrates a rare presentation of CPA tumor with symptoms of nausea and vomiting as a result of mass effect of the growing tumor. In addition, this review also shows the importance of regularly following up the patients with suspected CPA lesions on initial scans which will help with identifying the increase in size of lesion promptly and potentially preventing advanced complications of CPA tumors. We suggest regular monitoring of these patients to timely manage the lesion and avoid the potential life-threatening complications.展开更多
文摘目的探讨颅脑结构性病变所致癫痫的伽玛刀(γ-刀)治疗方法,评价治疗效果及视频脑电图(VEEG)随访的意义。方法回顾性分析山东省戴庄医院伽玛刀治疗科和神经科2017-01—2021-06确诊的60例颅脑结构性病变所致癫痫患者的临床资料,根据是否采用γ-刀治疗将其分为单纯药物治疗组(对照组)和γ-刀联合药物治疗组(γ-刀组),每组30例,进行随访观察,分析γ-刀治疗的效果及随访VEEG检测结果。结果在1~2 a的随访期内,γ-刀组患者癫痫总改善率76.67%,对照组为36.67%,差异有统计学意义(P<0.05);γ-刀组EEG痫样放电检出率30.00%,对照组为66.67%;γ-刀组癫痫控制显效组EEG正常率为50%,明显高于有效组的11.11%及无效组的0,显效组EEG痫样波检出率(7.14%)明显低于有效组(22.22%)和无效组(85.71%)。γ-刀治疗后随访期内癫痫发作改善率分别为0.5~1 a 63.33%,>1~2 a 76.67%,>2~3 a 80.77%,3 a以上82.61%;VEEG痫样波检出率分别为0.5~1 a63.33%,>1~2 a 30.00%,>2~3 a 23.08%,3 a以上21.74%。术后并发放射性脑水肿3例(10.00%)。结论γ-刀治疗颅内结构性病变所致的难治性癫痫效果明确,VEEG有助于γ-刀治疗方案的设计、评估治疗效果和指导治疗后用药。
文摘Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors. Most CPA tumors are benign, but can cause nerve damage or compress the surrounding structures if left untreated. The typical presentation is with adult-onset sensorineural hearing loss or non-pulsatile tinnitus. In some patients, this goes unnoticed, and presentation is delayed until the lesion is much larger and presents with symptoms related to mass effect. We present the case study of 63 years old gentleman, who had suspected left CPA lesion on CT head done few years ago for dizziness and left-sided facial numbness. MRI could not be done at that time due to his MRI incompatible pacemaker leading to delay in his management eventually causing loss of patient to the follow up. He later developed progressive difficulty in walking which was initially attributed to as secondary to vasovagal syncope and postural hypotension. He eventually presented to us with intractable nausea and vomiting, worsening headache and ataxia. He had an urgent CT head which showed significant growth in the lesion with compression of the surrounding structures and obstructive hydrocephalus. He was given steroids which improved his nausea and vomiting, followed by undergoing surgery in regional center leading to significant improvement in his gait within few days of surgery. He unfortunately continued to have a degree of ataxia and facial numbness. This case illustrates a rare presentation of CPA tumor with symptoms of nausea and vomiting as a result of mass effect of the growing tumor. In addition, this review also shows the importance of regularly following up the patients with suspected CPA lesions on initial scans which will help with identifying the increase in size of lesion promptly and potentially preventing advanced complications of CPA tumors. We suggest regular monitoring of these patients to timely manage the lesion and avoid the potential life-threatening complications.
