脑动静脉畸形切除术后新发癫痫：536 例全国数据库研究。

Postoperative de novo epilepsy after resection of brain arteriovenous malformations: A national database study of 536 patients.

机构信息

Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.

Department of Neurological Surgery, Montefiore/Albert Einstein College of Medicine, Bronx, New York, USA.

出版信息

Epilepsia. 2023 Nov;64(11):2914-2921. doi: 10.1111/epi.17765. Epub 2023 Sep 8.

DOI:10.1111/epi.17765

PMID:37638560

Abstract

OBJECTIVE

We aimed to assess the incidence and risk factors for de novo epilepsy after arteriovenous malformation (AVM) resection and compare them with a nonresection cohort after propensity score matching, utilizing a national database.

METHODS

Utilizing the TriNetX Research Network, we queried cases from January 1, 2004 to March 1, 2022. We included patients of all ages who underwent supratentorial AVM resection, presenting without seizures on or before surgery and without being on antiseizure medications at least 1 day before surgery. The primary outcome was seizures manifesting at least 6 weeks after surgery. Patient characteristics and outcomes were compared between the cohorts with and without postoperative epilepsy. Further cohorts were created to compare cohorts with and without embolization or rupture. After propensity score matching, we compared an additional cohort of patients with an AVM diagnosis who did not undergo resection.

RESULTS

Of the 536 patients (mean age = 38.9 ± 19.6, 52% females) presenting without seizure who underwent AVM resection, 99 (18.5%) developed de novo epilepsy, with a 1-year cumulative incidence of 13.8%. Patients with epilepsy had higher rates of intracerebral hemorrhage, and intracerebral hemorrhage was less common in the embolization cohort. Patients in the ruptured cohort were older and more often males. After propensity score matching with 18 588 patients with AVM diagnosis but no resection, each group consisted of 529 patients, and de novo epilepsy at 1 year was significantly higher in the AVM resection cohort compared to the nonresection cohort (11.5% vs. 3.4%, p < .001).

SIGNIFICANCE

This analysis of 536 patients provides evidence that de novo epilepsy after brain AVM resection occurs at a 1-year cumulative incidence of 13.8%, with a total of 19.4% developing de novo epilepsy. Intracerebral hemorrhage was inconsistently associated with postoperative de novo epilepsy. De novo epilepsy was significantly less frequent after AVM diagnosis without resection.

摘要

目的

我们旨在评估动静脉畸形（AVM）切除术后新发癫痫的发生率和风险因素，并利用国家数据库，通过倾向评分匹配将其与非切除队列进行比较。

方法

利用 TriNetX 研究网络，我们从 2004 年 1 月 1 日至 2022 年 3 月 1 日查询病例。我们纳入了所有接受幕上 AVM 切除术的年龄患者，术前无癫痫发作，且术前至少 1 天未服用抗癫痫药物。主要结局是术后至少 6 周出现癫痫发作。比较术后有无癫痫发作的队列之间的患者特征和结局。进一步创建了亚组，以比较有无栓塞或破裂的亚组。在倾向评分匹配后，我们比较了一个未行切除术的 AVM 诊断患者的附加队列。

结果

在 536 例（平均年龄 38.9 ± 19.6 岁，52%为女性）无癫痫发作接受 AVM 切除术的患者中，99 例（18.5%）新发癫痫，1 年累积发病率为 13.8%。癫痫患者颅内出血发生率较高，栓塞组颅内出血较少。破裂组患者年龄较大，男性较多。与 536 例无 AVM 切除但诊断为 AVM 的患者进行倾向评分匹配后，每组各有 529 例，1 年新发癫痫在 AVM 切除术组明显高于非切除术组（11.5%比 3.4%，p < 0.001）。