伴发癫痫的优势半球外侧裂脑动静脉畸形手术治疗1例并文献复习-《临床神经外科杂志》

文章信息/Info

Title:: Dominant hemispheric sylvian fissure arteriovenous malformations present with epilepsy: report of 1 case with literature reviews

Keywords:: Arteriovenous malformations; Sylvian fissure; Epilepsy; Awake anesthesia; Surgical procedures

摘要:: 目的：探讨外侧裂脑动静脉畸形的手术策略及效果。方法：回顾性分析1例伴发癫痫的优势半球外侧裂动静脉畸形患者的临床资料并结合文献复习，对外侧裂动静脉畸形的解剖特点、临床解剖分型、术前功能评估、术中辅助技术的应用以及治疗策略等进行分析讨论。结果：本例患者在唤醒麻醉下完整切除，术后言语及运动功能无加重，随访10个月，无癫痫发作，EngelⅠ级。结论：外侧裂脑动静脉畸形术前功能评估及术中功能保护极其重要，唤醒麻醉下结合皮层电刺激可以有效保护脑功能区。神经导航辅助下，经皮层功能哑区脑沟入路优先阻断深部供血动脉，可有效控制术中出血。

Abstract:: Objective: To discuss the clinical characteristics and surgical strategy of the sylvian fissure arteriovenous malformations (AVMs). Methods: The clinical data of 1 patient with sylvian fissure AVMs in the dominant hemisphere were analyzed retrospectively. The anatomical features, preoperative evaluation and surgical strategy were discussed combined with literatures review. Results: The AVMs and the epileptic foci were totally resected under awake anesthesia. There were no new neurological deficits postoperatively. During the ten-month follow-up period, the patient achieved seizure free after operation. Conclusion: Sylvian fissure AVMs are among the most challenging AVMs to manage surgically. The functional evaluation and intraoperative protection of functional structure are extremely important in the surgical treatment of sylvian fissure AVMs. It is effective to protect important functional brain areas through brain mapping. To block the deep blood supply artery via the sulcus in the “dumb area” can effectively control the surgical bleeding.