Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Neurosurg Focus. 2010 Sep;29(3):E16. doi: 10.3171/2010.6.FOCUS10127.
Microsurgical resection of supratentorial cavernomas associated with intractable epilepsy is performed frequently. Despite its common occurrence, little is known about patient perceptions of microsurgical resection for cavernomas. This survey study was performed to investigate patient perceived outcome after surgery for cavernomas associated with intractable epilepsy.
The authors' surgical database was searched for cavernoma resection performed between 1971 and July of 2006. Of the initial 173 patients identified, 102 met criteria for medically intractable seizures. These 102 patients were then mailed a survey to determine follow-up and patient satisfaction. Thirty-nine surveys were returned as undeliverable, and 30 (48%) of the remaining 63 patients responded.
The average age at surgery for patients responding to this survey was 40 +/- 16 years compared with 35 +/- 15 years for all 102 patients. At prolonged follow-up, 87% of patients reported being seizure-free. Of those with seizures, 2 (7%) reported being nearly seizure-free (rare disabling seizures), 2 (7%) believed they had a worthwhile improvement in seizure frequency, and no patient (0%) in this series believed they did not have a worthwhile improvement in seizure frequency. Ninety percent of responders stated they definitely, and 10% probably, would have surgery again. No patient responded that they probably or definitely would not have epilepsy surgery. Mean clinical follow-up was 36 +/- 8 months and survey follow-up was 97 +/- 13 months for these 30 patients. Use of the mail-in survey increased follow-up length 2.7 times longer compared with clinical follow-up.
It is clear from this select group of survey responders that patients undergoing surgery for cavernomas associated with medically intractable epilepsy are happy they underwent surgery (100%) and had excellent surgical outcomes (87% seizure-free) at prolonged follow-up of 97 +/- 13 months. These survey results support that microsurgical resection for cavernomas is highly effective and significantly improves these patients' quality of life.
幕上海绵状血管畸形伴耐药性癫痫的显微切除术经常进行。尽管这种手术很常见，但人们对海绵状血管畸形患者对手术的看法知之甚少。本研究通过调查，研究与耐药性癫痫相关的海绵状血管畸形患者手术后的感知结果。
作者对 1971 年至 2006 年 7 月期间行海绵状血管畸形切除术的手术数据库进行了检索。最初确定的 173 例患者中，有 102 例符合耐药性癫痫的标准。然后对这 102 例患者进行邮寄调查，以确定随访和患者满意度。有 39 份调查无法投递，在其余 63 例患者中，有 30 例（48%）做出了回应。
这项调查中，对回复患者的平均手术年龄为 40±16 岁，而所有 102 例患者的平均年龄为 35±15 岁。在长期随访中，87%的患者报告无癫痫发作。在有癫痫发作的患者中，2 例（7%）报告几乎无癫痫发作（罕见的致残性癫痫发作），2 例（7%）认为癫痫发作频率有明显改善，而本研究中无患者（0%）认为癫痫发作频率没有明显改善。90%的患者表示肯定会再次接受手术，10%的患者可能会再次接受手术。没有患者表示可能或肯定不会接受癫痫手术。这 30 例患者的平均临床随访时间为 36±8 个月，调查随访时间为 97±13 个月。与临床随访相比，邮件调查的使用使随访时间延长了 2.7 倍。
从这组有代表性的调查应答者可以清楚地看出，接受手术治疗与耐药性癫痫相关的海绵状血管畸形的患者（100%）对手术感到满意，并且在长达 97±13 个月的随访中取得了极好的手术结果（87%无癫痫发作）。这些调查结果表明，海绵状血管畸形的显微切除术非常有效，显著改善了这些患者的生活质量。
