Analysis Of The Effect Of Excision And Embolization On Secondary Epilepsy Of Cerebral Arteriovenous Malformation

Background:cerebral arteriovenous malformation,CAVM,is an abnormal structure of tissue development of the primitive cerebral vascular or the formation of neovascularization,the absence of capillaries,abnormal arteriovenous anastomosis,and hemodynamic disorders of the cerebral vascular disease.Secondary epilepsy is a common clinical manifestation of CAVM.It is also the most common clinical manifestation of some complex and giant CAVM.The presence of CAVM was found with convulsions and loss of consciousness as the first examination.After partial epilepsy,anti-epileptic drugs(AEDs)was used for treatment,and the detection time was prolonged.Before operation,the course of disease varied,and most arteriovenous malformations tended to increase with growth and development.The pathogenesis of CAVM and the interaction between epilepsy and CAVM are not completely clear.S-M classification,location,clinical manifestation,general condition of patients and orientation of patients are the main reference factors for treatment.The treatment strategies include microsurgical resection,endovascular embolization and stereotactic radiosurgery.After treatment,CAVM has been eliminated or partially occluded,and bleeding risk is effectively excluded.Some patients with epilepsy disappeared,some patients with poor control of epilepsy,even aggravated,failed to achieve the desired effect of treatment;some patients showed no epilepsy before operation,new epilepsy after operation.The process of CAVM treatment ended,but the goal was not fully achieved,which increased the barriers of communication and mutual trust between doctors and patients.There are few reports about how to control the seizure in a better way.Therefore,to compare the differences of epileptic seizures between different treatments before and after different treatment methods,explore the influencing factors of secondary epilepsy of CAVM,and better treat epilepsy on the basis of effective occlusion and elimination of malformed groups,which is a development direction for accurate and effective treatment of CAVM.Based on the long history of CAVM treatment,microsurgical resection and intravascular embolization balanced development,functional department of Neurosurgery,electroencephalogram monitoring,intraoperative electrophysiological monitoring and other disciplines and auxiliary technologies are coordinated to explore the effects of the two treatments on secondary epilepsy with science,necessity and feasibility.Objective:To explore the effects of microsurgical resection and intravascular embolization on two cases of secondary epilepsy of cerebral arteriovenous malformations,analyze the risk factors of internal epilepsy,and choose a reasonable treatment.To enhance communication between doctors and patients and increase mutual trust between doctors and patients;accurate and efficient treatment of cerebral arteriovenous malformation on the basis of effective occlusion of cerebral arteriovenous malformation.Methods:Comparison of epileptic seizures before and after microsurgical resection and endovascular embolization in patients with cerebral arteriovenous malformation in recent years,The differences of epileptic seizures between the two methods were treated.Analysis of related factors of secondary epilepsy of arteriovenous malformation.Results:1、A total of 86 patients with CAVM were treated with 46 cases of excision and 40 cases of embolization.In the resection group,13 cases of epileptic seizures before operation,6 cases of epilepsy disappeared after operation accounted for 13%of the group,7 cases without change accounted for 15.2%of the group,no epilepsy before operation,7 cases of new attack after operation accounted for 15.2%of the group.In the embolization group,there were 11 cases of epileptic seizures before operation,7 cases of epilepsy disappeared after operation,7 cases accounted for 17.5%,and no change in 4 cases accounted for 10%of the group.There were no epilepsy before operation and 3 cases of new attack after operation accounted for 7.5%of the group.2.Young men are the prone factors of CAVM and epilepsy;In location,epilepsy occurs more frequently in frontal lobe,temporal lobe and multiple brain lobe than in other parts;large malformed volume and high grade are internal factors of CAVM,which are prone to epilepsy.The onset of symptoms is long and the frequency of epilepsy is more,it is the adverse factor of postoperative epilepsy;complete resection,one-time effective embolization,shortening the history of CAVM and shortening the time of epileptic formation are conducive to the elimination and control of epilepsy.Conclusions:1、Cerebral arteriovenous malformation secondary epilepsy has been improved after two ways of excision and embolization.Patients with long seizure time and high frequency before operation had poor control of epilepsy,new onset of epilepsy in a small number of patients.The formation factors of CAVM and its relationship with epilepsy need further study.2、Compared with microsurgical excision,In all CAVM cases,embolized operation has better control over the occurrence of tonic clonic seizures Preoperative and lower incidence of postoperative new onset.3、The excision procedure can completely eliminate the CAVM stimulant factors of epileptic formation in a short time.Complete embolism and effective change of hemodynamics may be the key to the control of epileptic seizures.