Long-Term Outcomes of Surgical Treatment in 181 Patients with Supratentorial Cerebral Cavernous Malformation-Associated Epilepsy
Long-Term Outcomes of Surgical Treatment in 181 Patients with Supratentorial Cerebral Cavernous Malformation-Associated Epilepsy
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181 例幕上脑海绵状血管瘤相关癫痫患者手术治疗的长期结果。
DOI：
10.1016/j.wneu.2017.08.095
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发表时间：
2017-12-01
影响因子：
2
通讯作者：
Mao, Ying
中科院分区：
文献类型：
--
作者：
He, Kangmin;Jiang, Shize;Mao, Ying
目的：为了评估手术治疗幕上脑海绵状血管畸形相关癫痫（SCCMAE）的疗效，并确定影响outcomes.METHODS的因素：在2005年至2009年的5年期间，本研究包括181例连续患者被诊断为SCCMAE和手术治疗在一个单一的机构。术后随访5年以上。采用Kaplan-Meier曲线和考克斯回归模型进行时间-事件分析，以评估相关的风险factors.Results：癫痫发作时的年龄为30.6 +/- 14.3岁，手术时的年龄为33.4 +/- 14.6岁。男女比例为0.81：1。脑海绵状血管畸形平均直径2.0cm。对于涉及功能区的CCM，CCM被移除（14例）或不（28例）外周含铁血黄素。所有患者均无长期神经功能障碍。在6个月、1年、2.5年和5年随访后，分别有89.0%、83.4%、81.8%和80.1%的患者达到Engel I级结局。在1年后为I级的患者中，术后5年癫痫缓解的患病率为96.0%（95%置信区间，94.4%-97.6%）。结论：本研究支持使用手术治疗SCCMAE的疗效。较短的术前癫痫持续时间与术后更好的癫痫控制相关，1年随访时的患者状态是长期Engel I级癫痫控制的可靠指标。
OBJECTIVE: To evaluate the efficacy of surgery as a treatment for supratentorial cerebral cavernous malformation-associated epilepsy (SCCMAE) and determine the factors that influence outcomes.METHODS: During the 5-year period from 2005 to 2009, this study included 181 consecutive patients who were diagnosed with SCCMAE and surgically treated in a single institution. Each patient was followed up for at least 5 years postoperatively. A time-to-event analysis was performed using Kaplan-Meier curves and Cox regression models to evaluate the associated risk factors.RESULTS: The age at seizure onset was 30.6 +/- 14.3 years, and the age at the time of surgery was 33.4 +/- 14.6 years. The female/male ratio was 0.81:1. The mean diameter of the cerebral cavernous malformations (CCMs) was 2.0 cm. For CCMs involving eloquent brain areas, the CCM was removed with (in 14 cases) or without (in 28 lesions) the peripheral hemosiderin. None of the patients had long-term neurologic disabilities. An Engel class I outcome was achieved in 89.0%, 83.4%, 81.8%, and 80.1% of the patients after 6 months, 1 year, 2.5 years, and 5-years of follow-up, respectively. In patients who were class I after 1 year, the prevalence of seizure remission 5 years postoperatively was 96.0% (95% confidence interval, 94.4%-97.6%).CONCLUSIONS: This study supports the efficacy of using surgery to treat SCCMAE. A shorter duration of preoperative epilepsy was associated with better seizure control after surgery, and patient status at the 1-year follow-up was a reliable indicator of long-term Engel class I epilepsy control.