Stavrou Ioannis, Baumgartner Christoph, Frischer Josa M, Trattnig Siegfried, Knosp Engelbert
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Neurosurgery. 2008 Nov;63(5):888-96; discussion 897. doi: 10.1227/01.NEU.0000327881.72964.6E.
The goal of this study was to examine the long-term outcomes of 53 epilepsy patients who were surgically treated for supratentorial cavernomas in a single-center study and to assess both the duration of epilepsy and the resection of the hemosiderin rim for their prognostic relevance during extended follow-up.
Fifty-three patients underwent microsurgical resection of radiologically diagnosed supratentorial cavernomas. For the outcome analysis, they were divided into 2 groups: Group A (33 patients) with a preoperative duration of epilepsy of less than 2 years, and Group B (20 patients) with a preoperative duration of epilepsy of 2 years or more. The natural history of the cavernomas, localization and size of the lesions, use of antiepileptic drugs, surgery timing, and technique (removal or not of the surrounding gliosis) were evaluated retrospectively. The outcome of epilepsy was based on Engel's classification and the International League Against Epilepsy classification.
After a mean follow-up period of 8.1 years, 45 (84.9%) of the 53 patients were free from disabling seizures (Engel Class I), including 37 patients (69.8%) who were completely free of postoperative seizures (Engel Class IA); 43 patients (81.1%) were categorized as International League Against Epilepsy Class 1. Outcome was statistically significantly improved in the patient subgroup of our study in which patients underwent a resection of the surrounding gliosis after a preoperative duration of epilepsy of less than 2 years (Group A). There was no mortality, and only minor postoperative neurological deficits occurred in 7.5% of patients.
In a long-term follow-up period, 84.9% of the patients in the study could be evaluated as Engel Class I. The analysis of outcome showed that patients benefited significantly from early surgery and excision of the hemosiderin rim.
本研究的目的是在一项单中心研究中，检查53例因幕上海绵状血管瘤接受手术治疗的癫痫患者的长期预后，并在延长随访期间评估癫痫持续时间和含铁血黄素环切除对其预后的相关性。
53例患者接受了经放射学诊断的幕上海绵状血管瘤的显微手术切除。为了进行结果分析，他们被分为两组：A组（33例患者）术前癫痫持续时间少于2年，B组（20例患者）术前癫痫持续时间为2年或更长。回顾性评估海绵状血管瘤的自然病史、病变的定位和大小、抗癫痫药物的使用、手术时机和技术（是否切除周围胶质增生）。癫痫的结果基于恩格尔分类和国际抗癫痫联盟分类。
平均随访8.1年后，53例患者中有45例（84.9%）无致残性癫痫发作（恩格尔I级），其中37例（69.8%）术后完全无癫痫发作（恩格尔IA级）；43例患者（81.1%）被归类为国际抗癫痫联盟1级。在我们研究的患者亚组中，术前癫痫持续时间少于2年（A组）的患者在切除周围胶质增生后，结果在统计学上有显著改善。无死亡病例，仅7.5%的患者出现轻微术后神经功能缺损。
在长期随访期间，该研究中84.9%的患者可被评估为恩格尔I级。结果分析表明，患者从早期手术和切除含铁血黄素环中显著获益。
