Electrocorticography-guided resection of temporal cavernoma: is electrocorticography warranted and does it alter the surgical approach?
Electrocorticography-guided resection of temporal cavernoma: is electrocorticography warranted and does it alter the surgical approach?
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DOI：
10.3171/2008.10.jns08722
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发表时间：
2009-06
影响因子：
4.1
通讯作者：
Meyer FB
中科院分区：
文献类型：
--
作者：
Van Gompel JJ;Rubio J;Cascino GD;Worrell GA;Meyer FB
与癫痫相关的海绵状血管瘤是一个有趣的外科难题，关于是否应该进行单纯的皮损切除或量身定做的切除，特别是在考虑到认知损害的潜在的颞叶。尽管缺乏关于其在海绵状细胞瘤手术中的价值的数据，但这一决定通常是由皮质脑电图(ECoG)指导的。本研究的目的有几个方面：第一，确定所有脑区海绵状细胞瘤切除后癫痫的结果；第二，评估皮层脑电在指导手术决策中的作用；第三，确定颞叶海绵状细胞瘤的最佳手术入路。作者从他们的外科数据库中确定了173名接受过海绵状肿瘤切除的患者。其中102名患者表现为癫痫，61名患者患有颞叶海绵状肿瘤。手术前，所有患者都由癫痫专家进行初步评估。平均随访37个月。无论海绵状血管瘤位于何处，手术均可获得良好的癫痫控制率：术后2年，88%的患者出现Engel I级预后。61例颞叶海绵状细胞瘤中，35例累及内侧结构。在患有颞叶海绵状血管瘤的患者中，接受皮层脑膜瘤切除术的患者通常接受更广泛的实质切除，而不是病变切除(p<；0.0001)。在颞叶海绵状海绵状肿瘤患者中，使用ECoG后6个月的无癫痫发作发生率分别为79%(29例)和91%(23例)，1年后分别为77%(22例)和90%(20例)，2年后分别为79%(14例)和83%(18例)。海绵状血管瘤的手术切除通常会导致良好的癫痫结果。对于颞叶海绵状血管瘤，皮层脑电引导下的切除范围越大，癫痫的预后越好。除了坚持点燃的概念，这项研究中的数据还支持在癫痫患者的颞叶海绵状细胞瘤手术中使用ECoG。
Cavernous hemangiomas associated with epilepsy present an interesting surgical dilemma in terms of whether one should perform a pure lesionectomy or tailored resection, especially in the temporal lobe given the potential for cognitive damage. This decision is often guided by electrocorticography (ECoG), despite the lack of data regarding its value in cavernoma surgery. The purpose of the present study was several-fold: first, to determine the epilepsy outcome following resection of cavernomas in all brain regions; second, to evaluate the usefulness of ECoG in guiding surgical decision making; and third, to determine the optimum surgical approach for temporal lobe cavernomas. The authors identified from their surgical database 173 patients who had undergone resection of cavernomas. One hundred two of these patients presented with epilepsy, and 61 harbored temporal lobe cavernomas. Preoperatively, all patients were initially evaluated by an epileptologist. The mean follow-up was 37 months. Regardless of the cavernoma location, surgery resulted in an excellent seizure control rate: Engel Class I outcome in 88% of patients at 2 years postoperatively. Of 61 patients with temporal lobe cavernomas, the mesial structures were involved in 35. Among the patients with temporal lobe cavernomas, those who underwent ECoG typically had a more extensive parenchymal resection rather than a lesionectomy (p < 0.0001). The use of ECoG in cases of temporal lobe cavernomas resulted in a superior seizure-free outcome: 79% (29 patients) versus 91% (23 patients) of patients at 6 months postresection, 77% (22 patients) versus 90% (20 patients) at 1 year, and 79% (14 patients) versus 83% (18 patients) at 2 years without ECoG versus with ECoG, respectively. The surgical removal of cavernomas most often leads to an excellent epilepsy outcome. In cases of temporal lobe cavernomas, the more extensive the ECoG-guided resection, the better the seizure outcome. In addition to upholding the concept of kindling, the data in this study support the use of ECoG in temporal lobe cavernoma surgery in patients presenting with epilepsy.