摘要
目的 探讨脑动静脉畸形(cAVM)并发癫(癎)发作的危险因素以及治疗和预后.方法 回顾性分析36例cAVM患者的临床特征及基线资料.根据是否并发癫(癎)分为癫(癎)组(15例)和对照组(21例),分析年龄、性别、畸形血管大小、位置、供血动脉数目、是否合并出血及动静脉瘤等因素与癫(癎)发作的相关性.观察癫(癎)组的癫(癎)发作类型、发作频率以及药物治疗反应情况.结果 癫(癎)组cAVM最大径为(34.13±14.71)mm,对照组为(24.29±9.48)mm.癫(癎)组病灶最常见部位:额叶9例(60.0%)、颞叶4例(26.7%)及枕叶2例(13.3%);对照组最常见部位:枕叶7例(33.3%)、额叶5例(23.8%)、颞叶5例(23.8%).病灶位于额叶(P=0.041)及病灶最大直径(P=0.033)是cAVM发生癫(癎)的独立危险因素.癫(癎)组9/15例(60.0%)经治疗未再发作,2/15例(13.3%)持续每年1次或更少发作,3/15例(20.0%)为每月1次全面发作,1/15例(6.7%)持续每周至每月1次发作.结论 对于病灶直径较大和位于额叶的cAVM患者,需要采取更积极的监测和干预措施,以减少癫(癎)风险,改善患者的生活质量.
Abstract
Aim To investigate the risk factors,treatment,and prognosis of epilepsy associated with cerebral arteriovenous malformations(cAVM).Methods A retrospective analysis of the clinical characteristics and baseline data of 36 patients with cAVM was conducted.The patients were divided into two groups based on the presence of epilepsy:a epilepsy group(15 cases)and a control group(21 cases).Factors such as age,gender,size of malformed vessels,location,number of feeding arteries,presence of hemorrhage,and arteriovenous aneurysm were analyzed for their correlation with epilepsy.The type of epileptic seizures,seizure frequency,and response to drug treatment were observed in the epilepsy group.Results The maximum AVM diameter was(34.13±14.71)mm in the epilepsy group and(24.29±9.48)mm in the control group.There were frontal lobe 9 cases(60.0%),temporal lobe 4 cases(26.7%)and occipital lobe 2 cases(13.3%)in the most common sites of lesions in the epilepsy group.There were frontal lobe 5 cases(23.8%),temporal lobe 5 cases(23.8%)and occipital lobe 7 cases(33.3%)in the most common sites in the control group.Lesions in the frontal lobe(P=0.041)and larger lesion diameter(P=0.033)were identified as independent risk factors for epilepsy in cAVM.In the epilepsy group,9/15 cases(60.0%)had no further seizures after the treatment,2/15 cases(13.3%)had one or fewer seizures per year,3/15 cases(20.0%)had one generalized seizure per month,and 1/15 cases(6.7%)had weekly to monthly seizures.Conclusion For AVM patients with larger lesion diameters and frontal lobe involvement,more aggressive monitoring and interventions are needed to reduce the risk of epilepsy and improve the patients'quality of life.
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