Okishev D N, Belousova O B, Éliava Sh Sh, Filatov Iu M, Sazonova O B, Shekhtman O D
Zh Vopr Neirokhir Im N N Burdenko. 2012;76(4):3-11; discussion 11.
Supratentorial compartment is the most frequent cavernomas location associated with seizures in 50-79% cases. Surgical removal of some cavernomas remains a delicate decision. To assess long-term epilepsy results in consecutive series of patients treated for supratentorial cavernomas.
Single-center retrospective study of 302 patients (2002-2010) with operated supratentorial cavernomas was performed. Male: female ratio= 139:163, age ranged 1 to 68 years, mean: 26.4. Multiple lesion were diagnosed in 27 (8.9%) patients, eloquent in 77 (24.9%) cases. Mean follow up was 55.2 months. Functional outcomes using modified Rankin scale and epilepsy outcomes using Engel scale were assessed. Data were statistically analyzed in respect to natural history, lesion type, location, size, extent of resection, use of anti-epileptic drugs, etc. Seizures suffered 74.8% of patients, generalized seizures--79.6% from those who have an epilepsy. In 34.5% of patients epileptic symptoms tended to worsen over time. Seizures improved in 78.2% patients post op, 62.3%--became seizure-free. Early surgery and less than 5 seizures in history were found a reliable predictors of better epilepsy outcome. Drug-resistant subgroup was associated with worse outcomes. Resection of gliosis and tailored ECoG-guided resection with respect to epilepsy outcome were not proved beneficial. Long-term disability was 9%, 3% in non-eloquent and 21% in eloquent and deep cavernomas group. One patient died (0.3%). Surgery remains an effective treatment for recurrent hemorrhage prevention and seizure control with acceptable morbidity. The benefits of surgery for eloquent and deep-seated cavernomas must be accurately weighted with higher risks. For symptomatic non-eloquent cavernomas surgical excision should be considered as soon as possible after disease onset.
幕上腔是最常见的海绵状血管瘤部位，50 - 79%的病例与癫痫发作相关。对于一些海绵状血管瘤，手术切除仍是一个棘手的决定。为评估连续系列幕上海绵状血管瘤患者的长期癫痫治疗结果。
对302例（2002 - 2010年）接受幕上海绵状血管瘤手术的患者进行单中心回顾性研究。男女比例为139:163，年龄范围为1至68岁，平均年龄为26.4岁。27例（8.9%）患者诊断为多发病变，77例（24.9%）病变累及功能区。平均随访时间为55.2个月。采用改良Rankin量表评估功能结局，采用Engel量表评估癫痫结局。对自然病史、病变类型、位置、大小、切除范围、抗癫痫药物使用等数据进行统计学分析。74.8%的患者有癫痫发作，全身性发作占癫痫患者的79.6%。34.5%的患者癫痫症状随时间有加重趋势。78.2%的患者术后癫痫发作改善，62.3%的患者无癫痫发作。早期手术和既往癫痫发作少于5次被发现是癫痫结局较好的可靠预测因素。耐药亚组与较差结局相关。未证实切除胶质增生和根据癫痫结局进行的定制脑电皮层电图引导下切除有益。长期残疾率为9%，非功能区病变患者为3%，功能区及深部海绵状血管瘤患者为21%。1例患者死亡（0.3%）。手术仍然是预防复发性出血和控制癫痫发作的有效治疗方法，发病率可接受。对于功能区及深部海绵状血管瘤，手术的益处必须与更高的风险进行准确权衡。对于有症状的非功能区海绵状血管瘤，应在疾病发作后尽快考虑手术切除。
