Department of Neurosurgery, University of Bonn Medical Centre, Bonn, Germany.
Epilepsia. 2013 Sep;54(9):1699-706. doi: 10.1111/epi.12327. Epub 2013 Aug 14.
Precise outcome data about the surgical therapy of cerebral cavernous malformation (CCM)-associated epilepsy is scarce regarding different epilepsy types, surgical approach, and outcome. Long-term outcome in patients with CCM-associated epilepsy is analyzed in a large single-center series.
Seizure outcome data >24 months was available in 118 patients. The influence of different parameters of preoperative workup and surgical technique was analyzed with regard to seizure outcome.
The study cohort comprised 76 patients with drug-resistant epilepsy (DRE), 20 patients with chronic epilepsy that did not meet the definition of DRE, as well as 22 patients with sporadic seizures. Temporal localization of CCMs predisposed to develop DRE. Detailed epileptologic workup was performed in 85 patients; invasive monitoring was done in 23 (37%) of 76 DRE cases. In 84% of DRE cases more extensive resections were performed. Mean follow-up varied between 107 and 137 months for the three groups. Seizure freedom in DRE was 88%, in chronic epilepsy 80%, and in sporadic seizures was 91%. Longer symptom duration was associated with worse seizure outcome. Outcome of patients who underwent invasive monitoring was not worse. The outcome in CCM-associated DRE can be good if more extensive resections are used and if noninvasive and/or invasive presurgical epileptologic workup is used whenever indicated. DRE was considerably more frequent in the temporal lobe, suggesting that temporal localization predisposes development of DRE. Seizure freedom rates were stable over a long period.
Surgical therapy of CCM-associated seizures and epilepsy can be successful if different surgical techniques according to presurgical evaluation are realized. To prevent clinical worsening into DRE, surgical intervention in CCM-associated epilepsy may be considered early.
关于不同癫痫类型、手术入路和结局，脑动静脉畸形（CAVM）相关性癫痫的手术治疗精确结果数据稀缺。本研究分析了大型单中心系列患者中 CAVM 相关性癫痫的长期结果。
118 例患者的随访时间＞24 个月，分析了术前检查和手术技术的不同参数对癫痫结果的影响。
研究队列包括 76 例耐药性癫痫（DRE）患者、20 例不符合 DRE 定义的慢性癫痫患者和 22 例偶发性癫痫患者。CAVM 的颞叶定位与 DRE 的发生相关。85 例患者进行了详细的癫痫学检查；23 例（37%）DRE 患者进行了有创监测。84%的 DRE 病例进行了更广泛的切除。三组的平均随访时间为 107-137 个月。DRE 患者的癫痫无发作率为 88%，慢性癫痫为 80%，偶发性癫痫为 91%。症状持续时间较长与癫痫结果较差相关。接受有创监测的患者的结果并不差。如果使用更广泛的切除，如果在有指征的情况下使用非侵入性和/或有创术前癫痫学检查，CAVM 相关性 DRE 的患者可以获得良好的结果。DRE 在颞叶更常见，提示颞叶定位易导致 DRE 的发生。癫痫无发作率在很长一段时间内保持稳定。
如果根据术前评估采用不同的手术技术，CAVM 相关性癫痫的手术治疗可以取得成功。为了防止临床恶化到 DRE，CAVM 相关性癫痫的手术干预可能需要早期考虑。
