海绵状血管畸形与癫痫的研究课件

Surgical management and long- term seizure outcome after epilepsy surgery for different types of epilepsy associated with cerebral cavernous malformations Precise outcome data about the surgical therapy of cerebral cavernous malformation (CCM) associated epilepsy is scarce regarding different epilepsy types, surgical approach, and outcome. Long-term outcome in patients with CCM-associated epilepsy is analyzed in a large single-center series. Purpose Methods Seizure outcome data 24 months was available in 118 patients. The influence of different parameters of preoperative workup and surgical technique was analyzed with regard to seizure outcome. Key Findings drug-resistant epilepsy (DRE),76例 chronic epilepsy 20 例 sporadic seizures 22例 Temporal localization of CCM predisposed to develop DRE. Detailed epileptologic workup was performed in 85 patients; invasive monitoring was done in 23 (37%) of 76 DRE cases. Mean follow-up varied between 107 and 137 months for the three groups. Seizure freedom ； in DRE was 88%, in chronic epilepsy 80%, in sporadic seizures was 91%. Longer symptom duration was associated with worse seizure outcome. Significance Surgical therapy of CCM-associated seizures and epilepsy can be successful if different surgical techniques according to presurgical evaluation arerealized. To prevent clinical worsening into DRE, surgical intervention in CCM-associated epilepsy may be considered early. 发病率等 Cerebral cavernous Malformations (CCMs) account for 1015% of all vascular malformations in the adult brain (Batra et al., 2009). The incidence of CCMs is thought to range between 0.4% and 0.8% (Del Curling et al., 1991). Forty percent to 70% of patients who have supratentorial CCM present with epilepsy (Awad Ferrier et al., 2007). 发病率 Seizures most probably result from various effects of blood breakdown products in the perilesional cortical area。 The epileptogenicity of CCM is influenced by its localization, particularly archicortical or temporal lobe localization (Menzler et al., 2010). Patients with symptomatic CCM may present clinically with occasional epileptic seizures but they may also lead to chronic or even drug-resistant epilepsy (DRE) in about 3540% of all cases (Kondziolka et al., 1995; Porter et al., 1997; Chang et al., 2009). Up to 4% of all DRE patients were diagnosed with a CCM (Kuzniecky et al., 1987;Convers et al., 1990). 手术问题 There are two main causes to consider resection of symptomatic CCM: to prevent renewed symptomatic hemorrhage, which can cause persistent neurologic deficits,and to cure structural DRE. Seizure outcome after epilepsy surgery can be favorable in patients with single supratentorial CCMs compared with conservative treatment with antiepileptic drugs (AEDs) or other treatment modalities like irradiation (Robinson et al.,1991; Shih Hsu et al., 2007). Microsurgical removal of CCM is a well-established treatment both for cases with sporadic seizures and for chronic and/or DRE. Up to date there is still debate if the surgical removal of the hemosiderotic rim around the CCM is making seizure outcome more favorable. Cases of DRE require epilepsy surgery, which normally includes carefully presurgical epileptologic evaluation. One may argue if there is need for extended presurgical epileptogenic workup or whether it would be feasible to perform surgery without that. 提出问题 Are there differences in seizure outcome between patients with and without formal presurgical evaluations? Are there differences in seizure outcome regarding the presurgicalepilepsy type? Is the localization of CCM predictive for seizure type and postsurgical seizure outcome? The aim of thisstudy is to answer these three relevant questions in a large patient cohort from the Bonn epilepsy and cranial surgery database. Methods Inclusion criteria Exclusion criteria Demographic evaluation Designation of type of epilepsy Presurgical epileptologic workup Resection strategy Follow-up and seizure outcome Statistical analysis Results Demographic data： Table 1 Epilepsy type/seizure semiology Table 2 Preoperative workup Figure 1. Surgical management Figure 2. Surgical morbidity/mortality Postoperative seizure outcome Table 3 Discussion The limit of this study is its retrospective nature. Furthermore, we did not evaluate neuropsychological data to compare the potential subtle cognitive deficits after extended lesionectomy (Helmstaedter et al., 2002; Clusmann et al., 2004; Schramm & Clusmann, 2008). That is why extended lesionectomy as a standard cannot be proposed. The strengths of the study are the clear differentiation of the different types of epilepsy, the size of the study population, and the length of follow-up. Conclusions 1 The outcome in CCM-associated DRE can be very good if more extensive resections are used and if noninvasive and/or inva