Dodick D W, Cascino G D, Meyer F B
Department of Neurology, Mayo Clinic Rochester, Minnesota 55905.
Mayo Clin Proc. 1994 Aug;69(8):741-5. doi: 10.1016/s0025-6196(12)61091-x.
To review our recent experience with surgical treatment of patients with vascular malformations and intractable partial epilepsy.
We retrospectively studied 20 consecutive Mayo patients who had undergone surgical treatment of medically refractory partial epilepsy and had cerebral vascular malformations.
Seizures were the initial symptom in all 13 female and 7 male patients, none of whom had a history of a symptomatic intracerebral hemorrhage. Magnetic resonance imaging (MRI) or pathologic examination, or both, indicated the presence of remote hemorrhage associated with the vascular lesion in 18 patients. MRI disclosed 36 vascular malformations (32 cavernous and 4 arteriovenous malformations) in the 20 patients. MRI was more sensitive and specific than computed tomography for their detection and characterization. The operative strategy in all patients included complete resection of the vascular malformation. A modified Engel classification (based on four classes) was used to determine the outcome of seizures.
Postoperatively, 15 patients were free of seizures, and 3 patients had at least a 90% decrease in number of seizures. Only two patients had an unfavorable outcome. Neither the age at onset of seizures nor the duration of seizures seemed to affect the outcome. The site of the vascular malformation was less important than precise correlation between the site of onset of seizure activity and the corresponding vascular malformation. The presence of coexistent ipsilateral atrophy of the hippocampal formation should be sought, and the operative strategy should be appropriately modified.
In the absence of dual pathologic conditions, lesionectomy can yield a seizure-free outcome in patients with intractable partial epilepsy and cerebral vascular malformations.
回顾我们近期对血管畸形和顽固性部分性癫痫患者进行手术治疗的经验。
我们回顾性研究了连续20例梅奥诊所的患者，这些患者接受了针对药物难治性部分性癫痫且患有脑血管畸形的手术治疗。
所有13名女性和7名男性患者的首发症状均为癫痫发作，他们均无有症状性脑出血病史。磁共振成像（MRI）或病理检查，或两者均显示18例患者存在与血管病变相关的陈旧性出血。MRI在20例患者中发现了36个血管畸形（32个海绵状畸形和4个动静脉畸形）。MRI在检测和特征描述方面比计算机断层扫描更敏感和特异。所有患者的手术策略均包括完整切除血管畸形。采用改良的恩格尔分类法（基于四类）来确定癫痫发作的结果。
术后，15例患者无癫痫发作，3例患者癫痫发作次数至少减少了90%。只有2例患者预后不佳。癫痫发作的起始年龄和发作持续时间似乎均不影响预后。血管畸形的位置不如癫痫发作起始部位与相应血管畸形之间的精确关联重要。应寻找同侧海马结构是否存在并存萎缩，并适当修改手术策略。
在不存在双重病理状况的情况下，病灶切除术可使顽固性部分性癫痫和脑血管畸形患者实现无癫痫发作的结局。
