Kraemer D L, Griebel M L, Lee N, Friedman A H, Radtke R A
Swedish Epilepsy Center, Seattle, Washington 98122, USA.
Epilepsia. 1998 Jun;39(6):600-7. doi: 10.1111/j.1528-1157.1998.tb01428.x.
This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.
本回顾性研究报告了采用病灶切除术治疗药物难治性癫痫合并血管畸形患者的长期手术结果。为了确定手术成功和失败的预测因素，对手术失败情况进行了详细分析。
15例药物难治性癫痫合并血管造影隐匿性血管畸形（AOVM）的患者在杜克大学医学中心接受了病灶切除术。病灶切除术仅包括切除AOVM及周围含铁血黄素染色的脑组织，不使用皮质脑电图（ECoG）来指导切除。
11例（73%）患者在病灶切除术后无癫痫发作。3例无明显改善，1例患者可能在癫痫发作后死亡。发病年龄、癫痫持续时间、切除时年龄和性别均不影响手术结果。所有新皮质AOVM且脑电图结果与病灶部位相关的患者在病灶切除术后均无癫痫发作。治疗失败与存在多个颅内病变、脑电图定位不佳或结果弥散、正电子发射断层扫描（PET）成像不一致或病灶紧邻边缘系统有关。
对于精心挑选的隐匿性血管畸形合并癫痫患者，切除周围含铁血黄素染色脑组织的病灶切除术可被视为首选手术方式。
