Prediction of postoperative outcome with special respect to removal of hemosiderin fringe:: A study in patients with cavernous haemangiomas associated with symptomatic epilepsy
Prediction of postoperative outcome with special respect to removal of hemosiderin fringe:: A study in patients with cavernous haemangiomas associated with symptomatic epilepsy
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DOI：
10.1016/j.seizure.2007.01.001
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发表时间：
2007-04-01
影响因子：
3
通讯作者：
Stefan, H.
中科院分区：
文献类型：
--
作者：
Hammen, T.;Romstoeck, J.;Stefan, H.
目的：对30例海绵状海绵状细胞瘤所致症状性癫痫患者进行术后随访，探讨手术适应证、手术时机和手术方式对手术效果的影响。方法：对30例内科治疗无效的海绵状细胞瘤患者，根据高分辨率磁共振成像和高强度脑电-视频监测结果进行手术治疗。结果：(1)海绵状细胞瘤周围含铁血黄素边缘完整切除与术后癫痫发作次数减少相关，而不完全切除含铁血黄素边缘与手术后癫痫发作次数减少相关。(2)术中癫痫持续时间越短，术后预后越好，越有利于恢复。(3)术前无出血和单灶性癫痫发作是预后良好的预测因素，而双侧或多灶性癫痫发作区术后预后较差。(4)在双重病理(海绵状海绵体瘤合并海马区硬化)患者中，病变切除加海马区切除较单纯病变切除有更好的预后。结论：海绵状细胞瘤患者的术后结局应是进一步涉及大量患者的前瞻性多中心研究的主题。除了理想之外。手术时机和双重病理处理应考虑扩大切除的作用，包括病灶周围出血。(C)2007年英国癫痫协会。爱思唯尔有限公司出版。保留所有权利。
Purpose: In this study 30 patients with symptomatic epilepsy caused by cavernomas were investigated in a postoperative follow up study to assess predictors for postoperative outcome with respect to indications, time and approach of surgery.Methods: Thirty patients with cavernomas refractory to medical treatment were scheduled for surgery based on the findings of high-resolution MR imaging and intensive EEG-video monitoring. Postoperative outcome of epilepsy was assessed by follow-up examinations based on the basis of classification by Engel and the International League against epilepsy (ILAE).Results: The following variables were associated with good postoperative outcome: (1) complete resection of hemosiderin fringe surrounding the cavernoma was correlated to less postoperative seizure frequency versus incomplete resection of the hemosiderin fringe according to the outcome protocol of ILAE. (2) Lower duration of epilepsy at the time of operation was correlated to a better postoperative outcome with a benefit for recovery. (3) Absence of hemorrhage before surgery and unifocal seizure onset was a predictor for a favorable outcome, whereas bilateral or multifocal seizure onset zones showed poorer postoperative outcomes. (4) In patients with dual pathology (hippocampal sclerosis in addition to a cavernoma), lesionectomy plus hippocampectomy as opposed to Lesionectomy only, had a better outcome than single lesionectomy.Conclusion: Postoperative outcome in patients with cavernomas should be the topic of further prospective multicenter studies involving a large number of patients. In addition to the ideal. operation time and handling of dual pathology the role of extended resection including perilesional hemorrhages should be taken into account. (c) 2007 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.