本文選題：海綿狀血管瘤　切入點：癲癇　出處：《浙江大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：癲癇發(fā)作是幕上海綿狀血管畸形患者最常見的癥狀,41%-80%的患者至少有過1次癲癇發(fā)作。對于已有癲癇發(fā)作的患者,再次出現(xiàn)發(fā)作的機率是每年5.5%。最新的研究認為對于從未發(fā)生過出血或神經(jīng)功能障礙的海綿狀血管畸形患者,一旦有過1次癲癇發(fā)作,其接下來5年中癲癇再發(fā)的機率高達94%。雖然目前海綿狀血管畸形伴癲癇的最佳治療方案并不明確,但很多醫(yī)療中心采用手術(shù)治療的方法并取得良好效果。類似于其他的醫(yī)療中心,我科既往亦采用傳統(tǒng)的的神經(jīng)外科手術(shù)直接行病灶切除,但隨訪發(fā)現(xiàn)仍有不少比例的患者術(shù)后一直有癲癇發(fā)作,嚴重影響生活質(zhì)量。自2012年末我院癲癇中心成立以來,更多伴癲癇的幕上海綿狀血管畸形患者采用癲癇外科的評估和治療。 目的 本研究目的在于明確對于伴癲癇的顳葉海綿狀血管畸形患者,癲癇外科治療是否優(yōu)于傳統(tǒng)的神經(jīng)外科治療。 方法 本研究中的患者分為兩組,甲組和乙組的患者分別采用傳統(tǒng)的神經(jīng)外科手術(shù)和癲癇外科手術(shù)治療。甲組：2008年3月到2012年12月共11例伴癲癇的顳葉海綿狀血管瘤患者于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院神經(jīng)外科行手術(shù)治療,均至少隨訪2年；乙組：2012年9月到2014年4月共13例患者于我院癲癇中心行手術(shù)治療,均隨訪至少1年。術(shù)后采用電話或門診的形式隨訪。癲癇發(fā)作情況的評估采用Engel分級,術(shù)后神經(jīng)功能的評估采用改良的Rankin量表。年齡、病灶大小應(yīng)用t檢驗,其余因素如術(shù)前發(fā)作次數(shù)、病程、發(fā)作類型、病灶側(cè)別、手術(shù)部位和術(shù)中腦電使用應(yīng)用Fisher檢驗,P0.05認為有統(tǒng)計學(xué)差異。 結(jié)果 甲組和乙組術(shù)后1年的Engel Ⅰ級的患者比例分別為72.7%和100%。甲組患者術(shù)后隨訪25～81個月,平均42.5±17.5個月,Engel Ⅱ級7例(63.6%),其中Engel Ⅰa級6例(54.5%),Engel Ⅱ級2例(18.2%),Engel Ⅲ級和Ⅳ級各1例(9.1%)。最后隨訪時有3(27.3%)例在服用抗癲癇藥物,均為單藥治療(表格2)。乙組隨訪12～27個月,平均15.9±4.2個月,13例患者均為Engel Ⅰ級(100%),其中Engel Ⅰa級12例(92.3%),另1例(7.7%)為Engel Ⅰc級,較甲組有顯著性差異(P=0.009)。甲組11例術(shù)后mRS評分均為0分,一組13例患者中有7例評分為1分,均表現(xiàn)為輕度的記憶力下降。 結(jié)論 對于伴癲癇的顳葉海綿狀血管瘤患者,傳統(tǒng)神經(jīng)外科預(yù)期能達到63.6%的長期癲癇無發(fā)作率,而癲癇外科預(yù)期能達到100%的長期癲癇無發(fā)作率。雖然本研究的患者例數(shù)尚少,且癲癇外科治療的隨訪時間短,但初步結(jié)果顯示對于伴癲癇的顳葉海綿狀血管瘤患者,癲癇外科要優(yōu)于傳統(tǒng)神經(jīng)外科。
[Abstract]:Seizure is the most common symptom in supratentorial cavernous vascular malformation. 41- 80% of the patients have at least one seizure. The chance of a relapse is 5.5 per year. New research suggests that in patients with cavernous vascular malformations that have never experienced bleeding or neurological dysfunction, once they have had an epileptic seizure, The risk of recurrent epilepsy in the next five years is as high as 94. Although the best treatment for cavernous vascular malformation with epilepsy is not clear, But many medical centers have adopted surgical treatment and achieved good results. Similar to other medical centers, our department has also used traditional neurosurgical operations to remove lesions directly. However, the follow-up showed that a large proportion of the patients still had seizures after operation, which seriously affected the quality of life. Since the establishment of the epilepsy center in our hospital in end of 2012, More patients with supratentorial cavernous vascular malformation with epilepsy were evaluated and treated by epilepsy surgery. Purpose. The aim of this study was to determine whether epilepsy surgery is superior to traditional neurosurgery in the treatment of cavernous temporal lobe malformation with epilepsy. Method. The patients in this study were divided into two groups. Patients in group A and group B were treated with traditional neurosurgery and epilepsy surgery respectively. Group A: 11 patients with temporal lobe cavernous hemangioma with epilepsy from March 2008 to December 2012 were attached to the School of Medicine of Zhejiang University. Neurosurgery is performed in the second Hospital, All patients were followed up for at least 2 years, group B: from September 2012 to April 2014, 13 patients underwent surgical treatment in our epilepsy center, all of them were followed up for at least one year. All patients were followed up by telephone or outpatient service after operation. The epileptic seizures were assessed by Engel grade. The postoperative neurological function was evaluated by modified Rankin scale. Age and lesion size were measured by t test. Other factors such as preoperation attack frequency, course of disease, attack type, side of lesion, other factors, The site of operation and the use of intraoperative EEG were statistically different with Fisher test (P0.05). Results. The proportion of Engel grade 鈪，

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