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目的探讨伴有癫痫病史的幕上脑海绵状血管瘤(CA)的手术策略。方法回顾性分析57例伴有癫痫病史的幕上脑海绵状血管瘤患者的资料,依据癫痫发作情况将其分为顽固组(41例)和偶发(或初发)组(16例)。顽固组内行单纯病变切除者15例,行病变切除及致痫灶扩展切除者26例。分别分析其病灶部位、临床表现、切除范围与术后随访结果。结果57例患者均行显微手术治疗,40例部位深在,均运用导航指引术中定位。本组无远期神经功能障碍,术后癫痫控制EngleⅠ级45例(81.8%),EngleⅡ级4例(7.3%),EngleⅢ级4例(7.3%),EngleⅣ级2例(3.6%)。结论①幕上脑海绵状血管瘤伴发癫痫的患者应尽早行手术治疗。②对于初发或偶发癫痫患者,手术切除病变及周围含铁血黄素沉积带即可获得满意的癫痫控制;对于顽固性癫痫患者,在前者基础上加行致痫皮层切除或脑叶切除将获得更理想的效果。③脑磁图检查结合EEG对术前癫痫灶定位有较大帮助。
Objective To investigate the surgical strategy of supratentorial cavernous hemangioma (CA) with history of epilepsy. Methods The data of 57 patients with supratentorial cavernous hemangioma with epilepsy were retrospectively analyzed. According to the seizure status, they were divided into two groups: stubborn group (41 cases) and sporadic (or primary) group (16 cases). In the stubborn group, 15 patients underwent simple excision of the lesion, and 26 patients underwent excision and resection of the epileptogenic lesion. Analysis of the lesion site, clinical manifestations, resection range and postoperative follow-up results. Results All the 57 patients underwent microsurgical treatment and 40 patients were deep, all using navigation guidance. There was no long-term neurological dysfunction in this group. There were 45 cases (81.8%) of Engle grade I, 4 cases of Engle II grade (7.3%), 4 cases of Engle Ⅲ grade (7.3%) and 2 cases of Engle Ⅳ grade (3.6%) after operation. Conclusion ① supratentorial Cavernous hemangioma with epilepsy patients should be treated as soon as possible. ② for patients with first or episode epilepsy, surgical removal of lesions and the surrounding hemosiderin deposition zone to obtain satisfactory control of epilepsy; for patients with refractory epilepsy, the former based on the addition of epileptic cortex resection or lobectomy will be obtained More ideal effect. ③ magnetoencephalography combined with EEG preoperative localization of epileptic foci have a greater help.