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目的探讨以癫痫起病的幕上脑海绵状血管瘤(CCA)的治疗方法及影响术后癫痫控制率的相关因素。方法 2008年1月至2014年1月收治以癫痫起病的幕上CCA患者76例,其中药物组(不愿接受手术者)25例,口服抗癫痫药物治疗。显微手术组51例,显微手术切除病灶及致痫灶,术后继续抗癫痫药物治疗。所有患者出院后随访1~5年,按Engel分级评定疗效,Engel分级Ⅰ~Ⅱ级为疗效满意。结果显微手术组疗效满意45例(88.2%),药物治疗组癫痫疗效10例(40.0%),两组疗效满意率差异有统计学意义(P<0.05)。癫痫病程≤1年的患者术后疗效满意率明显高于癫痫病程>1年的患者(P<0.05)。结论以癫痫起病的幕上CCA显微手术治疗效果良好,建议尽早手术治疗;影响术后癫痫控制率的因素为癫痫的病程。
Objective To investigate the treatment of supratentorial cavernous hemangiomas (CCA) with epilepsy and the related factors that influence the rate of postoperative epilepsy control. Methods From January 2008 to January 2014, 76 patients with supratentorial CCA who had epilepsy were admitted. Among them, 25 patients in the drug group (unwilling to undergo surgery) were treated with oral antiepileptic drugs. In the microsurgery group, 51 patients underwent microsurgical resection of the lesion and epileptogenic zone and were treated with antiepileptic drugs after operation. All patients were followed up for 1 to 5 years after discharge, according to Engel grading evaluation efficacy, Engel grading Ⅰ ~ Ⅱ level for the efficacy of satisfaction. Results There were 45 cases (88.2%) in the microsurgery group and 10 cases (40.0%) in the epidural drug treatment group. There was significant difference in the satisfaction rate between the two groups (P <0.05). The satisfaction rate of patients with epilepsy ≤ 1 year after operation was significantly higher than that of patients with epilepsy> 1 year (P <0.05). Conclusion The supratentorial CCA microsurgery with epilepsy has a good effect. It is suggested that the operation be treated as soon as possible. The factors that influence the rate of postoperative epilepsy control are the course of epilepsy.