Cohen D S, Zubay G P, Goodman R R
Department of Neurological Surgery, Neurological Institute of New York, Columbia Presbyterian Medical Center, New York, USA.
J Neurosurg. 1995 Aug;83(2):237-42. doi: 10.3171/jns.1995.83.2.0237.
Cavernous malformations that are associated with seizures are often treated by surgical resection consisting of lesion removal, "lesionectomy," alone. Through retrospective analysis the authors have examined some factors that may predict failure to eradicate seizures by such a procedure. A group of 51 patients were examined who had been treated for supratentorial cavernous malformations with preoperative seizures and received postoperative follow up lasting at least 1 year. There was one mortality in the group. Of the remaining 50 patients, 15 (30%) had continued postoperative seizures despite therapeutic levels of antiepileptic medications. Variables that were significantly associated with continued seizures postoperatively included increasing duration of preoperative seizure history (p = 0.03), increasing number of preoperative seizures (p < 0.003), and female sex (p < 0.04). One hundred percent of patients with only one preoperative seizure or a seizure history lasting less than 2 months were seizure free following lesionectomy: approximately 75% to 80% of all patients with two to five seizures, or a seizure history lasting 2 to 12 months, were seizure free; and only 50% to 55% of those with more than five seizures or with preoperative seizure histories lasting more than 1 year were seizure free postoperatively. This investigation indicates that patients with shorter seizure histories and fewer preoperative seizures can be effectively treated by lesionectomy alone, whereas those with longer histories and more seizures are not effectively treated by this procedure and may require more extensive resections.
与癫痫发作相关的海绵状血管畸形通常仅通过切除病变的手术切除（即“病变切除术”）来治疗。通过回顾性分析，作者研究了一些可能预测这种手术无法根除癫痫发作的因素。对一组51例患者进行了检查，这些患者因幕上海绵状血管畸形伴术前癫痫发作接受治疗，并接受了至少1年的术后随访。该组有1例死亡。在其余50例患者中，15例（30%）尽管使用了治疗剂量的抗癫痫药物，但术后仍有癫痫发作。与术后持续癫痫发作显著相关的变量包括术前癫痫发作病史的持续时间增加（p = 0.03）、术前癫痫发作次数增加（p < 0.003）以及女性性别（p < 0.04）。术前仅有一次癫痫发作或癫痫发作病史持续时间少于2个月的患者，病变切除术后100%无癫痫发作；所有有2至5次癫痫发作或癫痫发作病史持续2至12个月的患者中，约75%至80%无癫痫发作；而术前癫痫发作超过5次或术前癫痫发作病史持续超过1年的患者中，术后仅有50%至55%无癫痫发作。这项研究表明，癫痫发作病史较短且术前癫痫发作次数较少的患者仅通过病变切除术即可有效治疗，而病史较长且癫痫发作较多的患者通过该手术无法有效治疗，可能需要更广泛的切除。
