Department of Neurosurgery, Helsinki University Central Hospital, Finland.
Acta Neurochir (Wien). 2011 Feb;153(2):261-70. doi: 10.1007/s00701-010-0812-5. Epub 2010 Sep 26.
Cavernomas of the temporal lobe occur in 10-20% of patients with cerebral cavernomas. They frequently cause epileptic seizures, some of which tend to become refractory to medical therapy. Surgical removal of safely achievable symptomatic lesions has been frequently consistent with good long-term outcome. In the present study, a postoperative outcome is assessed.
Of our 360 consecutive patients with cerebral cavernomas, 53 (15%) had a single cavernoma in the temporal lobe. Forty-nine patients were treated surgically and were included in the study. All data were analyzed retrospectively. The cavernomas were allocated into three groups based on the temporal lobe site: medial, anterolateral, and posterolateral. To collect follow-up data, all available patients were interviewed by phone. Seizure outcome was assessed using the Engel classification and general outcome using the Glasgow Outcome Scale (GOS).
Patients' median age at presentation was 37 (range, 7-64) years, with a female/male ratio of 2.5:1. Epileptic seizures occurred in 40 patients (82%). Median duration of seizures preoperatively was 3 (range, 0.1-23) years. In addition, four patients (10%) had memory disorder. Three patients without history of seizures (6%) complained of headache and two (4%) had memory problems. Three patients (6%) had an incidental cavernoma. Hemorrhage occurred in nine patients (18%) preoperatively. Median postoperative follow-up time was 6 (range, 0.2-26) years. Favorable seizure outcome (Engel class I and II) was registered in 35 patients (90%). Ten patients (25%) who had only a single seizure before surgery were seizure free during postoperative follow-up. Good general outcome (GOS, 4.5) was detected in 46 patients (96%). Two patients (4%) developed a new mild memory deficit after surgery, and in two patients existing memory deficits worsened.
Microsurgical removal of temporal lobe cavernomas is a safe and effective method to improve seizure outcome in patients with medically intractable epilepsy and to prevent deterioration caused by hemorrhage.
颞叶海绵状血管畸形占脑海绵状血管畸形患者的 10-20%。它们常引起癫痫发作，其中一些倾向于对药物治疗产生抗药性。安全可行的有症状病变的手术切除常与良好的长期预后相关。本研究评估了术后结果。
在我们的 360 例连续脑海绵状血管畸形患者中，53 例（15%）有单个颞叶海绵状血管畸形。49 例患者接受了手术治疗，并纳入了本研究。所有数据均进行回顾性分析。根据颞叶部位，将海绵状血管畸形分为三组：内侧、前外侧和后外侧。为了收集随访数据，通过电话对所有可获得的患者进行了访谈。采用 Engel 分类评估癫痫发作结果，采用格拉斯哥预后量表（GOS）评估总体预后。
患者发病时的中位年龄为 37 岁（范围，7-64 岁），女性/男性比例为 2.5:1。40 例（82%）患者出现癫痫发作。术前癫痫发作的中位持续时间为 3 年（范围，0.1-23 年）。此外，4 例（10%）患者有记忆障碍。3 例无癫痫发作史的患者（6%）诉头痛，2 例（4%）有记忆问题。3 例（6%）患者有偶然发现的海绵状血管畸形。术前出血 9 例（18%）。术后中位随访时间为 6 年（范围，0.2-26 年）。35 例（90%）患者的癫痫发作结果良好（Engel Ⅰ级和Ⅱ级）。10 例（25%）术前仅有单次癫痫发作的患者术后无癫痫发作。46 例（96%）患者总体预后良好（GOS，4.5）。2 例患者（4%）术后出现新的轻度记忆缺陷，2 例患者记忆缺陷恶化。
手术切除颞叶海绵状血管畸形是一种安全有效的方法，可以改善药物难治性癫痫患者的癫痫发作结果，并防止出血引起的恶化。
