血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

Prognosis of patients with unruptured cerebral arteriovenous malformation with epilepsy treated with endovascular embolization

摘要:

目的 分析血管内栓塞治疗未破裂脑动静脉畸形（CAVM）并发癫痫患者的预后情况。方法 选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象，分析血管内栓塞治疗后患者的临床症状、生活质量（QOLIE-31）改善情况。结果 患者经血管内栓塞治疗后，QOLIE-31各项指标（除了药物影响）评分均明显提高，高于治疗前（P<0.05）；Spetzler-Martin分级与Engel分级的I~Ⅱ级例数多于治疗前（P<0.05），同时Spetzler-Martin分级I~Ⅱ级生活质量评分（76.04±18.33）分明显高于Ⅲ~V级的（65.65±16.76）分（P<0.05）；Engel分级I~Ⅱ级的生活质量评分（75.25±17.78）分明显高于Ⅲ~V级的（66.23±13.22）分（P<0.05）；血管内栓塞比例>80%的生活质量总评分（78.37±18.87）分明显高于栓塞比例<80%的（64.16±16.92）分（P<0.05）；术后患者的头疼症状中重度例数明显低于治疗前（P<0.01）；患者的NIHSS评分和MRS评分均明显低于治疗前，头疼症状的生活质量评分高于治疗前（均P<0.05）。结论 血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损，提高血管内栓塞比例能够提高患者生活质量。

Abstract:

Objective To analyze the prognosis of patients with unruptured cerebral arteriovenous malformation (CAVM) with epilepsy treated with endovascular embolization.Methods A total of 49 patients with CAVM with epilepsy who were admitted to the hospital from March 2013 to June 2017 and met the diagnostic criteria were enrolled and analyzed for their improvements in the clinical symptoms and Quality of Life in Epilepsy-31 (QOLIE-31) after endovascular embolization.Results After treatment with endovascular embolization, the scores on all items (except for drug effects) of QOLIE-31 were significantly increased (P<0.05); the numbers of patients with Spetzler-Martin grade I-Ⅱ and Engel grade I-Ⅱ disease were significantly increased (P<0.05); Spetzler-Martin grade I-Ⅱ cases had significantly higher quality of life (QOL) scores than Spetzler-Martin grade Ⅲ-V cases (76.04±18.33 vs 65.65±16.76, P<0.05), and Engel grade I-Ⅱ cases had significantly higher QOL scores than Engel grade Ⅲ-V cases (75.25±17.78 vs 66.23±13.22, P<0.05); the total QOL score was significantly higher in patients with an endovascular embolization rate of >80% than in those with an endovascular embolization rate of <80% (78.37±18.87 vs 64.16±16.92, P<0.05); the number of patients with severe headache was significantly reduced (P<0.01); the National Institutes of Health Stroke Scale and Modified Rankin Scale scores were significantly decreased (P<0.05), and the QOL score of headache symptoms was significantly increased (P<0.05).Conclusions Endovascular embolization can significantly improve headache symptoms, epileptic seizures, and neurological deficits in patients with unruptured CAVM with epilepsy, indicating that increasing the rate of endovascular embolization can improve patients' QOL.