以癫痫起病的幕上脑海绵状血管瘤的治疗  

Treatment of supratentorial cerebral cavernous angioma associated with epilepsy as first symptom

作　　者：孙拯 谢延风[1] 石全红[1] 但炜[1] 詹彦[1] 陆波[1] 孙晓川[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《中国临床神经外科杂志》2015年第12期709-711,共3页Chinese Journal of Clinical Neurosurgery

基　　金：国家临床重点专科建设项目(财社[2011]170号)

摘　　要：目的探讨以癫痫起病的幕上脑海绵状血管瘤（CCA）的治疗方法及影响术后癫痫控制率的相关因素。方法 2008年1月至2014年1月收治以癫痫起病的幕上CCA患者76例,其中药物组（不愿接受手术者）25例,口服抗癫痫药物治疗。显微手术组51例,显微手术切除病灶及致痫灶,术后继续抗癫痫药物治疗。所有患者出院后随访1～5年,按Engel分级评定疗效,Engel分级Ⅰ～Ⅱ级为疗效满意。结果显微手术组疗效满意45例（88.2%）,药物治疗组癫痫疗效10例（40.0%）,两组疗效满意率差异有统计学意义（P〈0.05）。癫痫病程≤1年的患者术后疗效满意率明显高于癫痫病程〉1年的患者（P〈0.05）。结论以癫痫起病的幕上CCA显微手术治疗效果良好,建议尽早手术治疗;影响术后癫痫控制率的因素为癫痫的病程。Objectives To discuss the reasonable and effective method to treat the supratentorial cavernous angiomas associated with epilepsy as the first symptom and the factors related to the postoperative seizure control. Methods The clinical data of 76 cerebral cavernous angioma patients with epilepsy as the first symptom, who were treated in our department from January, 2008 to January, 2014, were analyzed retrospectively. Of 76 patients, 25 were treated by antieplileptic drugs and 51 by microsurgery and antiepleptic drugs after the surgery. All the patients were followed up from 1 to 5 years. Results The rate （88.2%, 45/51） of satisfactory control of seizure was significantly higher in the surgical treatment group than that （40.0%, 10/25） in the conservative treatment group （P〈0.05）. The rate （96.9%, 31/32） of satisfactory control of seizure after the surgery was significantly higher in the patients whose course of epilepsy is less than 1 year than that （73.7%, 14/19） in the patients whose course of epilepsy is more than 1 year （P〈0.05）. Conclusions The surgical treatment should be recommended in the patients with cerebral cavernous angiomas associated with epilepsy because its curative effect on the seizure is better than that of the conservative treatment. The Factors affecting the effects of surgical treatment on the seizure is the course of epilepsy.

关 键 词：脑海绵状血管瘤 癫痫 显微手术 疗效 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]