Seizure predictors and control after microsurgical resection of supratentorial arteriovenous malformations in 440 patients.
Seizure predictors and control after microsurgical resection of supratentorial arteriovenous malformations in 440 patients.
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DOI：
10.1227/neu.0b013e31825ea3ba
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发表时间：
2012-09
期刊：
影响因子：
4.8
通讯作者：
Lawton MT
中科院分区：
文献类型：
--
作者：
Englot DJ;Young WL;Han SJ;McCulloch CE;Chang EF;Lawton MT
癫痫发作是幕上动静脉畸形（AVM）的常见症状，不受控制的癫痫可显著降低患者的生活质量。AVM患者癫痫的潜在风险因素知之甚少，在手术治疗中实现无癫痫的重要性仍未得到充分认识。描述手术切除幕上AVM患者术前癫痫发作的风险因素以及与术后无癫痫相关的因素。我们分析了前瞻性收集的440例在我们机构接受幕上AVM显微手术切除术的患者数据。在440例幕上AVM患者中，130例（30%）发生了术前癫痫发作，23例（18%）癫痫发作患者进展为难治性癫痫。癫痫发作与AVM出血史（RR 6.65，95% CI 3.81-11.6）、男性（RR 2.07，95% CI 1.26-3.39）和额颞病变位置（RR 1.75，95% CI 1.05-2.93）相关。切除后，96%的患者具有改良Engel I级结局，其特征为无癫痫发作（80%）或仅一次术后癫痫发作（16%）（平均随访20.7 ± 2.3个月）。在有（7%）或无（3%）术前癫痫发作的患者中观察到术后癫痫发作的发生率相当。具有深动脉穿支的AVM与术后癫痫发作显著相关（HR 4.35，95% CI 1.61-11.7）。在幕上AVM的显微手术治疗中，出血、男性和额颞位置与术前癫痫发作的发生率较高相关，而深部动脉穿支与术后癫痫发作相关。实现无癫痫是AVM手术治疗中可以实现的一个重要目标，因为癫痫可显著降低患者的生活质量。
Seizures are a common symptom of supratentorial arteriovenous malformations (AVMs), and uncontrolled epilepsy can considerably reduce patient quality-of-life. Potential risk factors for epilepsy in patients with AVMs are poorly understood, and the importance of achieving seizure-freedom in their surgical treatment remains under-appreciated. To characterize risks factors for pre-operative seizures and factors associated with post-operative seizure-freedom in patients with surgically resected supratentorial AVMs. We analyzed prospectively-collected patient data for 440 patients who underwent microsurgical resection of supratentorial AVMs at our institution. Among 440 patients with supratentorial AVMs, 130 (30%) experienced pre-operative seizures, and 23 (18%) individuals with seizures progressed to medically refractory epilepsy. Seizures were associated with a history of AVM hemorrhage (RR 6.65, 95% CI 3.81-11.6), male gender (RR 2.07, 95% CI 1.26-3.39), and frontotemporal lesion location (RR 1.75, 95% CI 1.05-2.93). After resection, 96% of patients had a modified Engel class I outcome, characterized by seizure-freedom (80%) or only one post-operative seizure (16%) (mean follow-up 20.7 ± 2.3 months). Comparable rates of post-operative seizures were seen in patients with (7%) or without (3%) pre-operative seizures. AVMs with deep artery perforators were significantly associated with post-operative seizures (HR 4.35, 95% CI 1.61-11.7). In the microsurgical treatment of supratentorial AVMs, hemorrhage, male gender, and frontotemporal location are associated with higher rates of pre-operative seizures, while deep artery perforators are associated with post-operative seizures. Achieving seizure-freedom is an important goal that can be achieved in the surgical treatment of AVMs, as epilepsy can significantly diminish patient quality-of-life.