开颅手术后以癫痫发作为首发症状的皮质静脉梗死性脑出血11例临床分析  

Hemorrhage resulted from cortical venous infarction with seizure as first symptom after craniotomy:a clinical analysis of 11 patients

作　　者：郭效东 王振华 许鹏 刘明辉 郝文明 杨新超 路小奇 李经纶 姚安会 王本瀚 Guo Xiaodong;Wang Zhenhua;Xu Peng;Liu Minghui;Hao Wenming;Yang Xinchao;Lu Xiaoqi;Li Jinglun;Yao Anhui;Wang Benhan(Hospital of PLA Joint Logistic Support Force,Zhengzhou 450042,China)

机构地区：[1]中国人民解放军联勤保障部队第九八八医院全军神经外科中心,郑州450042

出　　处：《中华神经医学杂志》2023年第11期1121-1128,共8页Chinese Journal of Neuromedicine

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ202102205)。

摘　　要：目的分析开颅手术后以癫痫发作为首发症状的皮质静脉梗死性脑出血患者的临床特点及疗效。方法中国人民解放军联勤保障部队第九八八医院全军神经外科中心自2011年6月至2019年9月收治11例开颅手术后以癫痫发作为首发症状的皮质静脉梗死性脑出血患者,均为开颅术中皮质静脉损伤所致,原发病为脑膜瘤7例、对冲性额叶脑挫裂伤2例、高血压脑出血1例、强迫症1例。现回顾性分析患者的临床资料和疗效,末次随访时采用Engel分级评估患者癫痫发作的控制效果。结果11例患者术后4 h~7 d出现首次癫痫发作,其中局灶性知觉保留性发作2例、局灶性演变为双侧强直阵挛发作3例、全面性强直-阵挛发作6例。复查头颅CT显示术区或邻近部位皮质及皮质下散在出血9例(血肿量15~50 mL),急诊行开颅血肿清除+去骨瓣减压术治疗5例,急诊行单纯血肿清除术3例,保守治疗1例。复查头颅CT显示术区少量弥散性出血伴严重脑水肿2例,保守治疗2个月后一过性肢体瘫痪恢复。11例患者随访(4.5±1.7)年(2.3~7.0年),末次随访时恢复正常4例;一侧肢体轻度至中度偏瘫5例,右眼视力轻度下降1例,长期昏迷1例。癫痫控制效果:Engel分级Ⅰ级8例,Ⅱ级3例。结论彻底清除血肿及失活脑组织能有效控制开颅术后皮质静脉梗死性脑出血患者的癫痫发作及再次出血。Objective To summarize the clinical characteristics and efficacy of hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy.Methods Eleven patients with hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy admitted to Neurosurgical Center,988th Hospital of PLA Joint Logistic Support Force from June 2011 to September 2019 were chosen in our study;primary diseases included meningioma in 7 patients,contusion and laceration of frontal lobe in 2,hypertensive cerebral hemorrhage in 1,and obsessive-compulsive disorder in 1 patient.Epilepsy was the first symptom after craniotomy.Clinical characteristics and efficacy of these patients were analyzed retrospectively;seizure control efficacy was evaluated by Engel grading.Results First seizure occurred 4 h-7 d after craniotomy in these 11 patients,including 2 with focal sensory retention seizure,3 with focal bilateral tonic-clonic seizure,and 6 with general tonic-clonic seizure.Follow-up cranial CT revealed hematoma in surgical region,adjacent cortex or subcortex in 9 patients(hematoma volume:15-50 mL);emergency craniotomy(hematoma clearance)and decompressive craniectomy was performed in 5 patients;only emergency craniotomy(hematoma clearance)was performed in 3 patients;conservative treatment was performed in 1 patient.A small amount of diffuse bleeding with severe cerebral edema in the surgical region appeared in 2 patients,and the transient limb paralysis gradually recovered after 2 months of conservative treatment.Follow-up was performed for(4.5±1.7)years([2.3-7.0]years).During the last follow-up,4 patients were normal,5 patients had mild to moderate hemiplegia,1 had mild decreased vision in the right eye,and 1 had long-term coma.Epileptic control efficacy analysis indicated that 8 had Engel grading I and 3 grading II.Conclusion Complete removal of hematoma and inactivated brain tissues can effectively control seizures and rebleeding in patients with hemorrhage resulted from

关 键 词：癫痫发作 皮质静脉梗死性脑出血 皮质静脉 脑出血 静脉保护 

分 类 号：R743.34[医药卫生—神经病学与精神病学]