Dziedzic Tomasz A, Koczyk Kacper, Nowak Arkadiusz, Maj Edyta, Marchel Andrzej
Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland.
Department of Clinical Radiology, Medical University of Warsaw, Warszawa, Poland.
J Korean Neurosurg Soc. 2022 May;65(3):415-421. doi: 10.3340/jkns.2020.0224. Epub 2022 Apr 29.
Seizure recurrence after the first-ever seizure in patients with a supratentorial cerebral cavernous malformation (CCM) is almost certain, so the diagnosis and treatment of epilepsy is justified. The optimal method of management of these patients is still a matter of debate. The aim of our study was to identify factors associated with postoperative seizure control and assess the surgical morbidity rate.
We retrospectively analysed 45 consecutive patients with a supratentorial CCM and symptomatic epilepsy in a single centre. Pre- and postoperative epidemiological data, seizure-related patient histories, neuroimaging results, surgery details and outcomes were obtained from hospital medical records. Seizure outcomes were assessed at least 12 months after surgery.
Thirty-five patients (77.8%) were seizure free at the long-term follow-up (Engel class I); six (13,3%) had rare, nocturnal seizures (Engel class II); and four (8.9%) showed meaningful improvement (Engel class III). In 15 patients (33%) in the Engel I group; it was possible to discontinue antiepileptic medication. Although there was not statistical significance, our results suggest that patients can benefit from early surgery. No deaths occurred in our study, and mild postoperative neurologic deficits were observed in two patients (4%) at the long-term follow-up.
Surgical resection of CCMs should be considered in all patients with a supratentorial malformation and epilepsy due to the favourable surgical results in terms of the epileptic seizure control rate and low postoperative morbidity risk, despite the use of different predictors for the seizure outcome.
幕上脑海绵状血管畸形（CCM）患者首次发作后几乎肯定会出现癫痫复发，因此对癫痫进行诊断和治疗是合理的。这些患者的最佳治疗方法仍存在争议。我们研究的目的是确定与术后癫痫控制相关的因素，并评估手术发病率。
我们对单中心连续45例幕上CCM合并症状性癫痫的患者进行了回顾性分析。从医院病历中获取术前和术后的流行病学数据、与癫痫发作相关的患者病史、神经影像学结果、手术细节和结局。术后至少12个月评估癫痫发作结局。
35例患者（77.8%）在长期随访中无癫痫发作（Engel I级）；6例（13.3%）有罕见的夜间癫痫发作（Engel II级）；4例（8.9%）有显著改善（Engel III级）。在Engel I级组的15例患者（33%）中，有可能停用抗癫痫药物。尽管无统计学意义，但我们的结果表明患者可从早期手术中获益。我们的研究中无死亡病例，长期随访中有2例患者（4%）出现轻度术后神经功能缺损。
对于所有幕上畸形合并癫痫的患者，均应考虑手术切除CCM，因为就癫痫发作控制率和术后低发病风险而言，手术效果良好，尽管癫痫发作结局有不同的预测指标。
