| 【Background】Cerebral cavernous malformation(CCM))is one of the diseases of cerebral vascular malformation.CCM patients with headache as the first symptom account for about 20% Mel 52%.Symptomatic headache can sometimes seriously affect the quality of life of patients.However,there are few related studies,and only a few cases have been reported.At present,neurosurgeons have different ways to deal with this kind of patients,including drug treatment,surgical treatment and so on.The outcome of different treatment methods for this kind of patients is not clear.【Objective】To explore the clinical characteristics of cerebral cavernous malformation with headache as the first symptom,and to understand its drug efficacy,surgical efficacy and related factors of postoperative headache relief,so as to provide theoretical basis for the clinical diagnosis and treatment of CCM related headache(CRH).【Methods】Retrospective analysis of clinical data on 43 singularity CCM patients with headacheas the first symptoms were analyzed from January 2013 to January2018 at the First Hospital affiliated with Fujian Medical University:gender,age,past medical history,course of headache,analgesic effect,etc.The types of CRH headache were divided into migraine type,tension headache type and other types.An 11-point pain scale score(Numerical Rating Scale score,NRS)was used to evaluate and quantify headache and calculate the headache relief index(HRI =(Preoperative NRS-Postoperative/Follow-up NRS)/ Preoperative NRS),which defines the headache state as remission,deterioration,and invariance.The patient’s prognosis was evaluated using the modified Rankin scale(m RS),which was defined as adverse event outcomes with a m RS score of 2.Grouped by treatment: 27 cases(60.5%)in the surgical group and 16 cases(39.5%)in the conservative group.Statistical analysis of data and data to understand the clinical characteristics of CRH and therapeutic efficacy.【Results】In this research,the solitary CCM with headache as the first symptom accounted for 23.5% of all CCM patients.The incidencepopulation of CRH is mainly middle-aged,the incidence rate of men and women is close,no obvious gender tendency.Its clinical headache type is mainly migraine-like(60.5%),followed by similar tension headache(30.2%),mostly moderate headache(67.4%),nearly 70% of CRH patients are not effective.The CCM volume mean is 4.40±5.10cm~3,and most CCM volumes are less than 5cm~3(76.7%).Most of them were supratentorial(83.7%)which mainly occurred in frontal lobe,temporal lobe,and the infratentorial lesions(16.3%)mainly occurred in brainstem andcerebellum.Single-factor analysis: The severity of CRH was not correlated with the volume of CCM,but The course is a related factor affecting the degree of CRH(P=0.037).Short-term effect: 24 cases of headache relief in the surgical group,of which 10(41.7%)were completely relieved,3(11.1%)had unchanged in headache,no case was worse than before surgery,effective headache relief rate was 88.9%,and the conservative group(18.1%)significantly improved(P<0.001).Long-term efficacy: 21 patients(77.8%)of the surgical group had headache relief,of which 8(38.1%)were completely relieved,no headache deterioration,effective headache remission rate was 77.8%,but 7 patients had a more severe headache than when they were discharged from the hospital,the recurrence rate of headache after surgery was 25.9%.4 cases(25.0%)of the conservative group get headache improved,no complete remission,and 2(12.5%)had a worsening of the headache,and the effective headache relief rate in the surgical group was still significantly better than that of the conservative group(P<0.001).Univariate analysis of 43 patients with CRH showed that drug refractory,preoperative NRS value and surgical treatment were the related factors affecting the long-term remission of CRH(P<0.1).Multivariate Logistic regression analysis showed that surgical treatment(OR=12.635,95%CI=2.396-66.642,P=0.003)was the independent risk factor affecting the long-term remission of CRH.Univariate Logistic regression analysis of 27 patients in the surgical group: CCM position(supratentorial)and CCM volume(≥5cm~3)were related factors affecting long-term headache relief in CRH patients.Multivariate Logistic regression analysis showed that CCM volume(≥5cm~3)(OR=0.047,95%CI=0.003-0.854,P=0.039)was an independent risk factor for long-term headache relief in patients with CRH.Prognosis: The m RS score of patients in the surgical group decreased significantly compared to the pre-surgery period(P<0.001)and lower than that of patients in the conservative treatment group of the same period(P<0.001).The incidence of adverse prognosis outcomes in the surgical group(29.6%)was lower than that of the conservative group(50%),no statistical significance in the differences in the group(P=0.182).【Conclusion】CCM-related headache is a kind of secondary headache which often occurs in middle-aged people and has no gender orientation.The main types of headache are similar to migraine and tension headache,most of them are moderate headache,and the CCM isusually a small supratentorial lesion.The severity of the headache increases as the course of the disease progresses.Surgical resection of CCMcan effectively relieve CRHfor a long time,and surgical treatment is an independent risk factor for long-term headache relief in patients with CRH.Patients’ long-term quality of life can benefit from surgical treatment,and there is no higher risk of adverse event outcome.CCM volume is an independent risk factor for postoperativelong-term headache relief in patients with CRH,when the volume of CCM lesion is larger than 5cm ~3,the long-term effect of surgical resection is poor. |
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