海绵状血管畸形与癫痫的研究_1课件

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1、Surgicalmanagementandlong-termseizureoutcomeafterepilepsysurgeryfordifferenttypesofepilepsyassociatedwithcerebralcavernousmalformationsPreciseoutcomedataaboutthesurgicaltherapyofcerebralcavernousmalformation(CCM)–associatedepilepsyisscarceregardingdifferentepilepsyt

2、ypes,surgicalapproach,andoutcome.Long-termoutcomeinpatientswithCCM-associatedepilepsyisanalyzedinalargesingle-centerseries.PurposeMethodsSeizureoutcomedata>24monthswasavailablein118patients.Theinfluenceofdifferentparametersofpreoperativeworkupandsurgicaltechniquewasan

3、alyzedwithregardtoseizureoutcome.KeyFindingsdrug-resistantepilepsy(DRE),76例chronicepilepsy20例sporadicseizures22例TemporallocalizationofCCMpredisposedtodevelopDRE.Detailedepileptologicworkupwasperformedin85patients;invasivemonitoringwasdonein23(37%)of76DREcases.Meanfoll

4、ow-upvariedbetween107and137monthsforthethreegroups.Seizurefreedom；inDREwas88%,inchronicepilepsy80%,insporadicseizureswas91%.Longersymptomdurationwasassociatedwithworseseizureoutcome.SignificanceSurgicaltherapyofCCM-associatedseizuresandepilepsycanbesuccessfulifdiffere

5、ntsurgicaltechniquesaccordingtopresurgicalevaluationarerealized.TopreventclinicalworseningintoDRE,surgicalinterventioninCCM-associatedepilepsymaybeconsideredearly.发病率等CerebralcavernousMalformations(CCMs)accountfor10–15%ofallvascularmalformationsintheadultbrain(Batraet

6、al.,2009).TheincidenceofCCMsisthoughttorangebetween0.4%and0.8%(DelCurlingetal.,1991).Fortypercentto70%ofpatientswhohavesupratentorialCCMpresentwithepilepsy(Awad&Jabbour,2006;Ferrieretal.,2007).发病率Seizuresmostprobablyresultfromvariouseffectsofbloodbreakdownproductsinth

7、eperilesionalcorticalarea。TheepileptogenicityofCCMisinfluencedbyitslocalization,particularlyarchicorticalortemporallobelocalization(Menzleretal.,2010).PatientswithsymptomaticCCMmaypresentclinicallywithoccasionalepilepticseizuresbuttheymayalsoleadtochronicorevendrug-re

8、sistantepilepsy(DRE)inabout35–40%ofallcases(Kondziolkaetal.,1995;Porteretal.,1997;Changetal.,2009).Upto4%ofallDREpatientswer