ABSTRACT
<p><b>BACKGROUND</b>The aim of this study is to explore the treatment and outcome of epileptogenic temporal lobe cavernous malformations (CMs).</p><p><b>METHODS</b>We analyzed retrospectively the profiles of 52 patients diagnosed as temporal lobe CMs associated with epilepsy. Among the 52 cases, 11 underwent a direct resection of CM along with the adjacent zone of hemosiderin rim without electrocorticogram (ECoG) monitoring while the other 41 cases had operations under the guidance of ECoG. Forty-six patients were treated by lesionectomy + hemosiderin rim while the other six were treated by lesionectomy + hemosiderin rim along with extended epileptogenic zone resection. The locations of lesions, the duration of illness, the manifestation, the excision ranges and the outcomes of postoperative follow-up were analyzed, respectively.</p><p><b>RESULTS</b>All of the 52 patients were treated by microsurgery. There was no neurological deficit through the long-term follow-up. Outcomes of seizure control are as follows: 42 patients (80.8%) belong to Engel Class I, 5 patients (9.6%) belong to Engel Class II, 3 patients (5.8%) belong to Engel Class III and 2 patients (3.8%) belong to Engel Class IV.</p><p><b>CONCLUSION</b>Patients with epilepsy caused by temporal CMs should be treated as early as possible. Resection of the lesion and the surrounding hemosiderin zone is necessary. Moreover, an extended excision of epileptogenic cortex or cerebral lobes is needed to achieve a better prognosis if the ECoG indicates the existence of an extra epilepsy onset origin outside the lesion itself.</p>
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Electroencephalography , Epilepsy , General Surgery , Hemangioma, Cavernous, Central Nervous System , General Surgery , Retrospective Studies , Temporal Lobe , Pathology , General Surgery , Treatment OutcomeABSTRACT
Objective: To discuss the angioarchitectual characteristics of dural arteriovenous fistulas (DAVFs) and its appropriate therapeutic strategies. Methods: A total of 159 patients with DAVFs were retrospectively analyzed, including the clinical presentations, patterns of angioarchitecture. The appropriate therapeutic strategies, and the factors affecting the efficacy of treatmen were analyzed. Results: The patients with DAVFs were treated with different approaches. Sixty-nine patients with their DAVFs were treated in the cavernous sinus area, including type I (n = 58) and type II (n = 11); 41 patients in the lateral sinus area, including type I (n = 26), type II (n = 14) and type III (n = 1); 13 patients in the superior sagittal sinus area, including type I (n = 1), type II (n = 2) and type III (n = 10); 20 in the tentorial area, and 7 in the skull base area were all type III. There were 9 patients with multiple DAVFs. The main therapeutic approaches used were endovascular treatment. Postoperative angiography demonstrated that 79 patients were cured, 71 improved, and 9 failed. Postoperative complications were found in 9 patients, among them 8 were cured or improved and 1 died. Conclusion: The clinical presentation, treatment and prognosis depend upon the angioarchitecture, the location and the venous drainage patterns. Endovascular treatment is the first choice and chief therapeutic approach.
ABSTRACT
<p><b>OBJECTIVE</b>To discuss the diagnosis, treatment and prognosis of spinal dural arteriovenous fistulas (SDAVF).</p><p><b>METHODS</b>The clinical and following-up date from 110 patients with SDAVF diagnosed by spinal MRI and spinal angiography were analyzed retrospectively.</p><p><b>RESULTS</b>Draining vein between fistula and spinal cord was interrupted by laminectomy approach as first choice in 61 patients, by hemi-laminectomy approach in 37, and by endovascular embolization in 12, and re-operation due to recurrence after embolization in 3. Anticoagulation, hydration and early rehabilitation were used postoperatively. Complete disappearance of SDAVF was confirmed in all 106 patients who received postoperative spinal angiography. The para-medullary tortuous flow voids fully disappeared in 74 patients and partly disappeared in 15 on postoperative T(2)-weighted MRI. Follow up of 98 patients showed complete recovery in 54 patients, improvement in 34, and no change in 10. Three of the 10 patients were reoperated on because of recurrence 1 to 5 years after embolization.</p><p><b>CONCLUSIONS</b>SDAVF can produce good outcome after early diagnosis and treatment. Interruption of the draining vein between fistula and spinal cord by hemi-laminectomy approach is the first choice for the treatment of SDAVF.</p>