Analysis Of The Application Of Electrophysiological Monitoring In The Operation Of Epileptic-related Cavernous Hemangioma

Objective:In combination with the patients with cavernous hemangioma with epileptic seizures admitted to the department of neurosurgery of our hospital from January 2011 to June 2018,the application of neuroelectrophysiological monitoring in the operation of cavernous hemangioma related to epilepsy was discussed,as well as its significance in guiding the surgical efficacy and reducing postoperative complications such as epilepsy.Methods:From January 2011 to June 2018,retrospective analysis was performed on 60 cases with epileptics-related cavernous hemangioma were admitted to the neurosurgery department of our hospital for surgical treatment.From January 2011 to June 2018,32 cases of cavernous hemangioma with epilepsy without electrophysiol ogical monitoring as control group.From January 2011 to June 2018,28 cases of cavernous hemangioma with epilepsy who treated underwent intraoperative electrophysiological monitoring(IONM)as monitoring group.During the operation,cortical electroencephalogram(ECOG)monitoring was used to determine the exact location and range of epileptic foci for microsurgery.Patients were followed up for at least 6 months,and the frequency of seizures was assessed by Engel grading.SPSS software was used for statistical analysis of data,and the postoperative effective rate and long-term complications of epilepsy in the two groups were compared.Results:There were 60 patients in this group,32 cases in the control group and 28 cases in the monitoring group.Engle postoperative outcome classification:the control group 16 cases(Engel Ⅰ),9 cases(Enge Ⅱ),4 cases(Engel Ⅲ),3 cases(Engel Ⅳ);Level monitoring group 16 cases(Engel Ⅰ),8 cases(Engel Ⅱ),3 cases(Engel Ⅲ),1 case(Engel Ⅳ).There were 15 cases of new postoperative clinical manifestations in the control group and 6 cases of new postoperative clinical manifestations in the monitoring group.The patient took an antiepileptic drug for 3-6 months after the operation,and decided to reduce or stop the drug according to the fact that there was no clinical seizure and the electroencephalogram was normal.Control group according to the Engel effect of classification:Satisfaction group 78.13%(25/32)(Engel Ⅰ and Ⅱ),Dissatisfied group 21.87%(7/32)(Engel Ⅲ and Ⅳ);Postoperative new clinical manifestations include limb movement disorder 12.50%(4/32),language impairment 9.38%(3/32),hemorrhage 6.25%(2/32),intracranial infection 3.12%(1/32),mental symptoms 9.38%(3/32),memory loss 6.25%(2/32);Postoperative follow-up ranged from 6 months to 5 years,with an average of 2.1 years.Monitoring group of Engel effect of classification:Satisfaction group 85.71%(24/28)(Engel Ⅰ and Ⅱ),Dissatisfied group 14.29%(4/28)(EngelⅢandⅣ);Postoperative new clinical manifestations included mobility disorder 7.14%(2/28),speech disorder 7.14%(2/28),bleeding 3.57%%(l/28),and psychiatric symptoms 3.57%(1/28).Postoperative follow-up ranged from 6 months to 5 years,with an average of 2.8 years.Postoperative epilepsy satisfaction group was 78.13%、85.71%respectively,with no significant difference(P>0.05).After statistical analysis,the new clinical manifestations of the two groups was statistically significant,and the complications in the monitoring group were lower than those in the control group.Conclusions:Intracranial cavernous hemangioma is a central nervous vascular malformation,the patient can appear obvious bleeding,small bleeding or intracavitary hyperplasia makes the lesion enlarged,there is a space effect;Also can behave for epileptic or the cutin hyperplasia of tissue of periphery brain.The purpose of intervention is to prevent re-bleeding,eliminate the effect of occupation,eliminate or reduce seizures If the patients have epilepsy symptoms,most of them are medically refractory epilepsy,which seriously affects the quality of life of the patients.Therefore,the patients have an urgent psychological need to solve the epilepsy symptoms and have high expectations for the operation.Detailed inquiry of preoperative medical history,complete auxiliary examination and intraoperative auxiliary means are essential.Combined with the operation patients admitted to the department of neurosurgery of our hospital,after statistical analysis,it is concluded that for patients with cavernous hemangioma accompanied by epileptic seizures,intraoperative neuroelectrophysiological monitoring is safe and feasible.The use of intraoperative neuroelectrophysiological monitoring is of positive significance to both patients and surgeons.For cavernous hemangioma patients with epilepsy,intraoperative neuroelectrophysiological monitoring is safe and feasible.IONM can objectively reflect the motor function status of epileptic patients in real time,which is helpful for surgeons to grasp the scope and depth of lesion site during operation,under the premise of protecting its function,the lesion can be fully resected to obtain a good prognosis.At the same time,it is helpful to reduce the occurrence of postoperative complications,and the control of postoperative epilepsy needs to be further studied.