Wang Chun, Yu Xiaobo, Shrestha Sudeep, Qian Cong, Wang Lin, Chen Gao
Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Medicine (Baltimore). 2016 Jun;95(26):e4078. doi: 10.1097/MD.0000000000004078.
To explore a predicted model for postoperative seizure outcomes after the surgical resection of supratentorial cavernous malformations.This study was a retrospective review of consecutive patients with cerebral supratentorial cavernous malformations presenting with seizures. All patients underwent surgical resection of CCMs. Univariate and multivariate analyses were performed to determine the predictive value of the preoperative seizure frequency, seizure type, seizure duration, lesion location, lesion size, and the presence of residual hemosiderin.A total of 43 patients met the inclusion criteria. After a mean follow-up period of 40.95 months, 34 patients who were free from postoperative seizures were classified into Engel class I, and the remaining 9 patients were classified into Engel classes II-IV. A univariate analysis showed that the seizure frequency (χ = 13.440, P = 0.004) and seizure duration (χ = 5.145, P = 0.023) prior to surgery were associated with a worse postoperative seizure prognosis. Other covariates including age at onset, gender, a history of the medications taken, smoking status, family history, lesion characteristics, and the role of hemosiderin were not related to seizure outcomes. Logistic regression results demonstrated that the preoperative seizure frequency was an effective predictor (P = 0.004). The receiver operating characteristic curve indicated that area under the curve for the preoperative seizure frequency test was 0.833 (95% confidence interval 0.709-0.957, P = 0.002).The preoperative seizure frequency was a prognostic factor for postoperative seizure outcomes after surgical resection of supratentorial cavernous malformations. To obtain a favorable prognosis for CCM patients with preoperative seizures, early intervention might be a better choice.
探索幕上海绵状血管畸形手术切除术后癫痫发作结局的预测模型。本研究是对连续出现癫痫发作的幕上脑海绵状血管畸形患者进行的回顾性研究。所有患者均接受了海绵状血管畸形的手术切除。进行单因素和多因素分析以确定术前癫痫发作频率、癫痫发作类型、癫痫发作持续时间、病变位置、病变大小和残余含铁血黄素的存在的预测价值。共有43例患者符合纳入标准。平均随访40.95个月后，34例术后无癫痫发作的患者被归类为Engel I级，其余9例患者被归类为Engel II-IV级。单因素分析显示，术前癫痫发作频率（χ = 13.440，P = 0.004）和癫痫发作持续时间（χ = 5.145，P = 0.023）与术后癫痫发作预后较差相关。其他协变量，包括发病年龄、性别、用药史、吸烟状况、家族史、病变特征和含铁血黄素的作用，与癫痫发作结局无关。逻辑回归结果表明，术前癫痫发作频率是一个有效的预测指标（P = 0.004）。受试者工作特征曲线表明，术前癫痫发作频率测试的曲线下面积为0.833（95%置信区间0.709 - 0.957，P = 0.002）。术前癫痫发作频率是幕上海绵状血管畸形手术切除术后癫痫发作结局的一个预后因素。为使术前有癫痫发作的海绵状血管畸形患者获得良好预后，早期干预可能是更好的选择。
