海绵状血管畸形与癫痫的研究

Surgicalmanagementandlong-termseizureoutcomeafterepilepsysurgeryfordifferenttypesofepilepsyassociatedwithcerebralcavernousmalformations•Preciseoutcomedataaboutthesurgicaltherapyofcerebralcavernousmalformation(CCM)–associatedepilepsyisscarceregardingdifferentepilepsytypes,surgicalapproach,andoutcome.Long-termoutcomeinpatientswithCCM-associatedepilepsyisanalyzedinalargesingle-centerseries.PurposeMethods•Seizureoutcomedata24monthswasavailablein118patients.Theinfluenceofdifferentparametersofpreoperativeworkupandsurgicaltechniquewasanalyzedwithregardtoseizureoutcome.KeyFindingsdrug-resistantepilepsy(DRE),76例chronicepilepsy20例sporadicseizures22例•TemporallocalizationofCCMpredisposedtodevelopDRE.•Detailedepileptologicworkupwasperformedin85patients;invasivemonitoringwasdonein23(37%)of76DREcases.•Meanfollow-upvariedbetween107and137monthsforthethreegroups.•Seizurefreedom；inDREwas88%,inchronicepilepsy80%,insporadicseizureswas91%.Longersymptomdurationwasassociatedwithworseseizureoutcome.Significance•SurgicaltherapyofCCM-associatedseizuresandepilepsycanbesuccessfulifdifferentsurgicaltechniquesaccordingtopresurgicalevaluationarerealized.•TopreventclinicalworseningintoDRE,surgicalinterventioninCCM-associatedepilepsymaybeconsideredearly.发病率等•CerebralcavernousMalformations(CCMs)accountfor10–15%ofallvascularmalformationsintheadultbrain(Batraetal.,2009).•TheincidenceofCCMsisthoughttorangebetween0.4%and0.8%(DelCurlingetal.,1991).•Fortypercentto70%ofpatientswhohavesupratentorialCCMpresentwithepilepsy(Awad&Jabbour,2006;Ferrieretal.,2007).发病率•Seizuresmostprobablyresultfromvariouseffectsofbloodbreakdownproductsintheperilesionalcorticalarea。•TheepileptogenicityofCCMisinfluencedbyitslocalization,particularlyarchicorticalortemporallobelocalization(Menzler•etal.,2010).PatientswithsymptomaticCCMmaypresentclinicallywithoccasionalepilepticseizuresbuttheymayalsoleadtochronicorevendrug-resistantepilepsy(DRE)inabout35–40%ofallcases(Kondziolkaetal.,1995;Porteretal.,1997;Changetal.,2009).Upto4%ofallDREpatientswerediagnosedwithaCCM(Kuznieckyetal.,1987;Conversetal.,1990).手术问题•TherearetwomaincausestoconsiderresectionofsymptomaticCCM:topreventrenewedsymptomatichemorrhage,whichcancausepersistentneurologicdeficits,andtocurestructuralDRE.•SeizureoutcomeafterepilepsysurgerycanbefavorableinpatientswithsinglesupratentorialCCMscomparedwithconservativetreatmentwithantiepilepticdrugs(AEDs)orothertreatmentmodalitieslikeirradiation(Robinsonetal.,1991;Shih&Pan,2005;Hsuetal.,2007).•MicrosurgicalremovalofCCMisawell-establishedtreatmentbothfor•caseswithsporadicseizuresandforchronicand/orDRE.•UptodatethereisstilldebateifthesurgicalremovalofthehemosideroticrimaroundtheCCMismakingseizureoutcomemorefavorable.•CasesofDRErequireepilepsysurgery,whichnormallyincludescarefullypresurgicalepileptologicevaluation.•Onemayargueifthereisneedforextendedpresurgicalepileptogenicworkuporwhetheritwouldbefeasibletoperformsurgerywithoutthat.提出问题•Aretheredifferencesinseizureoutcomebetweenpatientswithandwithoutformalpresurgicalevaluations?•Aretheredifferencesinseizureoutcomeregardingthepresurgicalepilepsytype?•IsthelocalizationofCCMpredictiveforseizuretypeandpostsurgicalseizureoutcome?•TheaimofthisstudyistoanswerthesethreerelevantquestionsinalargepatientcohortfromtheBonnepilepsyandcranialsurgerydatabase.Methods•Inclusioncriteria•Exclusioncriteria•Demographicevaluation•Designationoftypeofepilepsy•Presurgicalepileptologicworkup•Resectionstrategy•Follow-upandseizureoutcome•StatisticalanalysisResults•Demographicdata：Table1•Epilepsytype/seizuresemiologyTable2PreoperativeworkupFigure1.•SurgicalmanagementFigure2.•Surgicalmorbidity/mortality•PostoperativeseizureoutcomeTable3Discussion•Thelimitofthisstudyisitsretrospectivenature.Furthermore,wedidnotevaluateneuropsychologicaldatatocomparethepotentialsubtlecognitivedeficitsafterextendedlesionectomy(Helmstaedteretal.,2002;Clusmannetal.,2004;Schramm&Clusmann,2008).Thatiswhyextendedlesionectomyasastandardcannotbeproposed.Thestrengthsofthestudyarethecleardifferentiationofthedifferenttypesofepilepsy,thesizeofthestudypopulation,andthelengthoffollow-up.Conclusions•1TheoutcomeinCCM-associatedDREcanbeverygoodifmoreextensiveresectionsareusedandifnoninvasiveand/orinvasivepresurgicalepileptologicworkupisusedwheneverindicated.•2DREwasconsiderablymorefrequentinthetemporallobe,suggestingthattemporallocalizationpredisposesthedevelopmentofDRE.•3Seizurefreedomrateswerestableoveralongperiod.