Department of Neurosurgery, Beijing Tiantan Hospital, China.
Can J Neurol Sci. 2011 Jan;38(1):48-53.
The findings of previous studies remain controversial on the optimal management required for effective seizure control after surgical excision of arteriovenous malformations (AVMs). We evaluated the efficacy of additional bipolar electrocoagulation on the electrically positive cortex guided by intraoperative electrocorticography (ECoG) for controlling cerebral AVMs-related epilepsy.
Sixty consecutive patients with seizure due to cerebral AVMs, who underwent surgical excision of cerebral AVMs and intraoperative ECoG, were assessed. The AVMs and surrounding hemosiderin stained tissue were completely removed, and bipolar electrocoagulation was applied on the surrounding cerebral cortex where epileptic discharges were monitored via intraoperative ECoG. Patients were followed up at three to six months after the surgery and then annually. We evaluated seizure outcome by using Engel's classification and postoperative complications.
Forty-nine patients (81.6%) were detected of epileptic discharges before and after AVMs excision. These patients underwent the removal of AVMs plus bipolar electrocoagulation on spike-positive site cortex. After electrocoagulation, 45 patients' epileptic discharges disappeared, while four obviously diminished. Fifty-five of 60 patients (91.7%) had follow-up lasting at least 22 months (mean 51.1 months; range 22-93 months). Determined by the Engel Seizure Outcome Scale, 39 patients (70.9%) were Class I, seven (12.7%) Class II, five (9.0%) Class III, and four (7.2%) Class IV.
Even after the complete removal of AVM and surrounding gliotic and hemosiderin stained tissue, a high-frequency residual spike remained on the surrounding cerebral cortex. Effective surgical seizure control can be achieved by carrying out additional bipolar electrocoagulation on the cortex guided by the intraoperative ECoG.
之前的研究结果在动静脉畸形（AVM）切除术后有效控制癫痫发作所需的最佳治疗方案上存在争议。我们评估了术中皮层脑电图（ECoG）引导下对电阳性皮层进行额外双极电凝治疗脑 AVM 相关癫痫的疗效。
我们评估了 60 例因脑 AVM 导致癫痫发作并接受脑 AVM 切除术和术中 ECoG 的连续患者。AVM 和周围含铁血黄素染色组织完全切除，在术中 ECoG 监测到癫痫放电的周围大脑皮层进行双极电凝。术后 3-6 个月及以后每年进行随访。我们采用 Engel 分级和术后并发症来评估癫痫发作的结果。
49 例患者（81.6%）在 AVM 切除前后均发现癫痫放电。这些患者接受了 AVM 切除术加棘波阳性部位皮层的双极电凝。电凝后，45 例患者的癫痫放电消失，4 例明显减少。60 例患者中有 55 例（91.7%）至少随访 22 个月（平均 51.1 个月；范围 22-93 个月）。根据 Engel 癫痫发作结果量表，39 例患者（70.9%）为 I 级，7 例（12.7%）为 II 级，5 例（9.0%）为 III 级，4 例（7.2%）为 IV 级。
即使在完全切除 AVM 及其周围的胶质和含铁血黄素染色组织后，周围大脑皮层仍存在高频残留棘波。术中 ECoG 引导下对皮层进行额外的双极电凝治疗，可以实现有效的手术癫痫控制。
