49例有癫痫发作的脑动静脉畸形术后癫痫预后分析

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英文题名：Postoperative Seizure Outcomes in a Series of 49 Patients with Brain Arteriovenous Malformations Associated with Seizures 作者：付辉 论文级别：硕士 学科专业名称：外科学 中文关键词：脑动静脉畸形 ; 癫痫发作 ; 皮层热灼 ; 预后 英文关键词：Brain arteriovenous malformations ; Seizure ; Bipolar-coagulation ; Outcome. 学位年度：2005 导师：赵继宗 学科代码：100210 学位授予单位：首都医科大学 论文提交日期：2005-03-01 答辩委员会主席：田增民

摘要

目的:回顾性分析1999年～2003年间经手术治疗的49例有癫痫发作表现的脑动静脉畸形患者。对这些患者的流行病学特点、临床特征、外科手术情况以及术后癫痫的预后情况加以评估。方法:对1999年1月至2003年1月间共4年的有癫痫发作表现的脑动静脉畸形患者数据收集分析。通过随访,以Engle癫痫疗效评定为标准,评估癫痫的总体疗效。同时,将所有病人按癫痫预后是否为ClassⅠ分为两组:一组术后无发作或仅有先兆,另一组术后仍有发作。对两组患者的以下变量进行比较:性别、年龄、侧别、部位、出血、AVMs直径、引流静脉、Spetzler-Martin分级、癫痫发作类型、术前癫痫病史长短、术前放疗、手术持续时间、术中脑室开放、皮层热灼、术后颅内感染。用统计学检验这些因素与癫痫预后的关系。结果:手术无死亡病例。癫痫的总体疗效较好,ClassⅠ31例,占63.3%;ClassⅡ11例,占22.45%;ClassⅢ5例,占10.2%;ClassⅣ2例,占4.08%。42例得到良好控制,良好率达86%。两组的所有评估变量均无显著性差异,但术中皮层热灼最接近有意义。结论:外科手术治疗有癫痫症状的脑动静脉畸形疗效确切,死亡率低于1%。术后癫痫控制率达86%,但未能找到影响癫痫预后的确切因素,术中辅以皮层热灼可能最有意义。
OBJECTIVE:A series of 49 postoperative patients with brain arteriovenous malformations associated with seizures between 1999 and 2003 were retrospectively analyzed. Their characteristics of epidemiology, clinical characteristics, surgical operations and seizure outcomes were assessed. METHODS: Collected data of patients with brain arteriovenous malformations associated with seizures between January 1999 and January 2003 were analyzed. As determined with the Engel Seizure Outcome Scale, we assessed the seizure outcomes of these patients via clinical follow-up monitoring. All these patients were classified into two groups by the seizure outcome of ClassⅠ(free of disabling seizures): GroupⅠwere free of disabling seizures and GroupⅡwere the others. We compared the following factors: sex, age, side, AVMs location, occurrence of intracranial hemorrhage, AVMs diameter, Venous drainage, Classification of Spetzler-Martin, seizure type, duration of seizure history, preoperative radiosurgery, duration of operation time, opened ventricle, Bipolar-coagulation, and intracranial infection. We tested for statistical associations between these factors and seizure outcomes. RESULTS: None of operative patients were dead. The seizure outcomes were satisfactory. As determined with the Engel Seizure Outcome Scale, there were 31 (63.3%) Class I (free of disabling seizures), 11 (22.45%) Class II (rare disabling seizures), 5 (10.2%) Class III (worthwhile improvement), and 2 (4.08%) Class IV (no worthwhile improvement) outcomes. The seizures of 42(86%) patients were
    
    
    controlled very well. All the variables were not associated with Class I outcomes. Probably, the Bipolar-coagulation was statistically associated with Class I outcomes. CONCLUSION: Surgical operation was an effective treatment of brain arteriovenous malformations associated with seizures. The mortality was less than 1%. The seizures of 86% patients can be controlled well by operation. The assured factors affecting the seizure outcomes were not be founded. Maybe the Bipolar-coagulation during the operation was an effective method to control the seizures.

引文

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