摘要目的 探讨以癫痫为主要表现的颞叶海绵状血管瘤(CCM)的手术治疗方法及疗效.方法 收集2010年1月至2016年9月在宁夏医科大学总医院神经外科手术治疗,伴发癫痫的颞叶CCM患者.以侧副沟为界,根据CCM位置将患者分为外侧组及内侧组.外侧组在术中皮层脑电监测下行病灶+含铁血黄素切除;内侧组根据病灶及含铁血黄素累及位置切除前颞叶及海马和(或)杏仁核.所有患者随访至少1年,癫痫预后采用Engel分级.结果 全部患者术后发作均显著改善,均未见远期并发症.外侧组8例患者,其中男2例,女6例,平均35岁,最后一次随访时Engel Ⅰ 级为100%.内侧组7例患者,其中男4例,女3例,平均52岁,Engel Ⅰ 级5例(71.8%),Engel Ⅱ 级(14%)及Ⅲ级(14%)各1例,Engel Ⅲ级为术中损伤脑发育性静脉异常(DVA),术后出现颞叶中后部静脉性梗死患者.结论 手术治疗CCM相关癫痫安全有效,癫痫预后与CCM位置密切相关,有关CCM伴发DVA的治疗策略仍需进一步研究.

abstractsObjective To evaluate the efficacy and safety of microsurgical in the treatment of temporal lobe cerebral cavernous malformation(CCM)with epilepsy.Methods Temporal lobe CCM patients with epilepsy admitted to our department were collected from January 2010 to September 2016. Locations of the CCM were divided into(1)lateral-lateral to the collateral sulcus;(2)mesial-mesial to the collateral sulcus.In the lateral group,patients were underwent intraoperative electrocorticography(ECoG)-guided resection of lesion and hemosiderin rim.In the medial group, a complete resection of the epileptogenic zone was performed in anterior temporal lobe and hippocampus and(or)amygdala according to lesion and hemosiderin rim.The follow-up period in all patients was at least 1 year.The outcome of epilepsy treatment was evaluated according to the standard Engel scale.Results Eight patients belong to the lateral group,including 2 males and 6 females,mean age at epilepsy surgery was 35 years old,100% of patients achieved Engel class Ⅰ the last follow up.The mesial group had 7 patients, including 4 males and 3 females,mean age at epilepsy surgery was 52 years old,71.8%of the patients were Engel Class Ⅰ,14%were Class Ⅱ, and 14% were Class Ⅲ.The patient who was Engel Class Ⅲ had a posterior temporal venous infarction due to injured the developmental venous anomalies(DVAs).Conclusions CCM Patients with epilepsy could benefit greatly from complete resection of hemosiderin rim and lesion.The epilepsy prognosis were closely correlated with the location of CCM.Further research is necessary to determine therapeutic strategies of CCMs with associated DVAs.