成人烟雾病联合血管重建术后癫痫发作特点及危险因素分析

doi:10.3969/j.issn.1672-6731.2022.07.007

中国现代神经疾病杂志 ›› 2022, Vol. 22 ›› Issue (7): 586-591. doi: 10.3969/j.issn.1672-6731.2022.07.007

2 成人烟雾病联合血管重建术后癫痫发作特点及危险因素分析

杨帅峰¹, 李雪华², 金立德¹, 陶维华¹, 钱希颖¹, 赵建华¹

1 650032 云南省第一人民医院昆明理工大学附属医院神经外科;
2 650032 昆明, 云南省疾病预防控制中心性病艾滋病防制所

收稿日期:2022-07-18 出版日期:2022-07-25 发布日期:2022-08-01
基金资助:
云南省科技厅昆明医科大学应用基础研究联合专项［项目编号：2019FE001（-160）］；云南省科技厅基础研究专项（项目编号：202201AT070014）；云南省第一人民医院临床医学中心开放课题（项目编号：2021LCZXXF-SJ04）；云南省第一人民医院临床医学中心开放课题（项目编号：2022LCZXKF-SJ03）

Analysis of risk factors for epileptic seizure after combined revascularization in adult patients with moyamoya disease

YANG Shuai-feng¹, LI Xue-hua², JIN Li-de¹, TAO Wei-hua¹, QIAN Xi-ying¹, ZHAO Jian-hua¹

1 Department of Neurosurgery, The First People's Hospital of Yunnan Province;The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China;
2 Department of AIDS/STDs Prevention and Control, Yunnan Center for Disease Control and Prevention, Kunming 650032, Yunnan, China

Received:2022-07-18 Online:2022-07-25 Published:2022-08-01
Contact: 杨帅峰,Email:yangshuaifeng7@163.com
Supported by:
This study was supported by Joint Project of Yunnan Science and Technology Department and Kunming Medical University[No. 2019FE001(-160)], Yunnan Fundamental Research Projects (No. 202201AT070014), Open Project of the Clinical Medical Center of The First People's Hospital of Yunnan Province (No. 2021LCZXXF-SJ04, 2022LCZXKF-SJ03).

摘要/Abstract

摘要： 目的总结烟雾病联合血管重建术后癫痫发作的临床特点并筛查相关影响因素。方法纳入云南省第一人民医院2015年1月至2021年6月收治的189例成人烟雾病联合血管重建术后患者，单因素和多因素前进法Logistic回归分析筛查联合血管重建术后癫痫发作的影响因素。结果 Logistic回归分析显示，术前有癫痫发作史（OR=5.523，95% CI：1.486~20.524；P=0.011）、桥血管位于额叶（OR=2.793，95% CI：1.027~7.597；P=0.044），以及术后并发脑梗死（OR=9.025，95% CI：2.121~38.404；P=0.003）、脑过度灌注综合征（OR=3.624，95% CI：1.281~10.253；P=0.015）和脑出血（OR=5.646，95% CI：1.219~26.142；P=0.027）是烟雾病患者术后癫痫发作的危险因素。结论术前有癫痫发作史、联合血管重建术桥血管位于额叶，以及术后并发脑梗死、脑过度灌注综合征和脑出血是成人烟雾病患者术后癫痫发作的危险因素，及时对危险因素进行干预，有可能减少术后癫痫发作。

关键词: 脑底异常血管网病, 脑血管重建术, 癫痫, 手术后并发症, 危险因素, Logistic模型

Abstract: Objective To summarize the clinical features of postoperative epileptic seizure in adults with moyamoya disease (MMD) treated with combined revascularization, and screen the related influencing factors. Methods Total 189 patients with MMD who underwent combined revascularization in Department of Neurosurgery of the First People's Hospital of Yunnan Province from January 2015 to June 2021 were included. Univariate and multivariate forward Logistic regression analysis was used to screen the influencing factors of epilepsy after combined revascularization in MMD patients. Results Logistic regression analysis showed preoperative seizure (OR=5.523, 95%CI:1.486-20.524; P=0.011), revascularization bypass vessel located in frontal lobe (OR=2.793, 95%CI:1.027-7.597; P=0.044), postoperative cerebral infarction (OR=9.025, 95%CI:2.121-38.404; P=0.003), cerebral hyperperfusion syndrome (OR=3.624, 95%CI:1.281-10.253; P=0.015) and intracranial hemorrhage (OR=5.646, 95%CI:1.219-26.142; P=0.027) were the risk factors of postoperative epileptic seizure in patients with MMD.Conclusions Preoperative seizure, revascularization bypass vessel located in frontal lobe, postoperative cerebral infarction, cerebral hyperperfusion syndrome and intracranial hemorrhage are the clinical risk factors of epileptic seizure in adult MMD patients, timely intervention of risk factors may reduce postoperative epileptic seizure in patients with MMD.

Key words: Moyamoya disease, Cerebral revascularization, Epilepsy, Postoperative complications, Risk factors, Logistic models

杨帅峰, 李雪华, 金立德, 陶维华, 钱希颖, 赵建华. 成人烟雾病联合血管重建术后癫痫发作特点及危险因素分析[J]. 中国现代神经疾病杂志, 2022, 22(7): 586-591.

YANG Shuai-feng, LI Xue-hua, JIN Li-de, TAO Wei-hua, QIAN Xi-ying, ZHAO Jian-hua. Analysis of risk factors for epileptic seizure after combined revascularization in adult patients with moyamoya disease[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2022, 22(7): 586-591.

http://journal11.magtechjournal.com/cjcnn/CN/Y2022/V22/I7/586

参考文献

[1] Chinese Expert Consensus Writing Group on Diagnosis and Treatment of Moyamoya Disease and Moyamoya Syndrome; Expert Committee on Stroke Prevention and Treatment, National Health and Family Planning Commission. Chinese expert consensus on diagnosis and treatment of moyamoya disease and moyamoya syndrome (2017)[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2017, 33:541-547.[烟雾病和烟雾综合征诊断与治疗中国专家共识编写组, 国家卫生计生委脑卒中防治专家委员会缺血性卒中外科专业委员会. 烟雾病和烟雾综合征诊断与治疗中国专家共识(2017)[J]. 中华神经外科杂志, 2017, 33:541-547.]
[2] Jeon JP, Kim JE, Cho WS, Bang JS, Son YJ, Oh CW. Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults[J]. J Neurosurg, 2018, 128:793-799.
[3] Kim H, Jang DK, Han YM, Sung JH, Park IS, Lee KS, Yang JH, Huh PW, Park YS, Kim DS, Han KD. Direct bypass versus indirect bypass in adult moyamoyaangiopathy with symptoms or hemodynamic instability:a meta-analysis of comparative studies[J]. World Neurosurg, 2016, 94:273-284.
[4] Yang H, Su JB, Ni W, Gao XJ, Lei Y, Jiang HQ, Gu YX. Risk factors for epilepsy after cerebral revascularization in patients with moyamoya disease[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2019, 35:664-668.[杨恒, 苏佳斌, 倪伟, 高信杰, 雷宇, 江汉强, 顾宇翔. 烟雾病脑血流重建术后癫痫发作的危险因素分析[J]. 中华神经外科杂志, 2019, 35:664-668.]
[5] Okuyama T, Kawabori M, Ito M, Sugiyama T, Kazumata K, Fujimura M. Outcomes of combined revascularization surgery for moyamoya disease without preoperative cerebral angiography[J]. World Neurosurg, 2022.[Epub ahead of print]
[6] Lopez-Gonzalez MA, Eastin M, Woo M, Ramanathan D, Gospodarev V, Wilson T, Zarabi H, Sharafeddin F. Minimally invasive cerebral revascularization in moyamoya disease in adult patients[J]. Neurochirurgie, 2022.[Epub ahead of print]
[7] China Association Against Epilepsy. Clinical diagnosis and treatment guidelines, Epilepsy Volume (2015 Revision)[M]. Beijing:People's Medical Publishing House, 2015.[中国抗癫痫协会. 临床诊疗指南癫痫病分册(2015修订版)[M]. 北京:人民卫生出版社, 2015.]
[8] Li G, Han GK, Zhang H, Li GH, Feng S, Jin F. Follow-up observation of cerebral-dural-arterial fusion in the treatment of adult moyamoya disease[J]. Zhonghua Shen Jing Wai Ke Za Zhi, 2017, 33:737-739.[李港, 韩光魁, 张浩, 李根华, 冯嵩, 靳峰. 脑-硬脑膜-动脉血管融通术治疗成人烟雾病的随访观察[J]. 中华神经外科杂志, 2017, 33:737-739.]
[9] Mikami T, Ochi S, Houkin K, Akiyama Y, Wanibuchi M, Mikuni N. Predictive factors for epilepsy in moyamoya disease[J]. J Stroke Cerebrovasc Dis, 2015, 24:17-23.
[10] Alramadan A, Ul Haq A, Basindwah S, Alshail E. Seizure outcome in moyamoya after indirect revascularization in pediatric patients:retrospective study and literature review[J]. Surg Neurol Int, 2021, 12:73.
[11] Ma Y, Zhao M, Zhang Q, Liu X, Zhang D, Wang S, Zhang Y, Li M, Zhao J. Risk factors for epilepsy recurrence after revascularization in pediatric patients with moyamoya disease[J]. J Stroke Cerebrovasc Dis, 2018, 27:740-746.
[12] Strzelczyk A, Haag A, Raupach H, Herrendorf G, Hamer HM, Rosenow F. Prospective evaluation of a post-stroke epilepsy risk scale[J]. J Neurol, 2010, 257:1322-1326.
[13] Choi JI, Ha SK, Lim DJ, Kim SD. Differential clinical outcomes following encephalo duro arterio synan giosis in pediatric moyamoya disease presenting with epilepsy or ischemia[J]. Childs Nerv Syst, 2015, 31:713-720.
[14] Englot DJ, Han SJ, Lawton MT, Chang EF. Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations[J]. J Neurosurg, 2011, 115:1169-1174.
[15] Po'C, Nosadini M, Zedde M, Pascarella R, Mirone G, Cicala D, Rosati A, Cosi A, Toldo I, Colombatti R, Martelli P, Iodice A, Accorsi P, Giordano L, Savasta S, Foiadelli T, Sanfilippo G, Lafe E, Thyrion FZ, Polonara G, Campa S, Raviglione F, Scelsa B, Bova SM, Greco F, Cordelli DM, Cirillo L, Toni F, Baro V, Causin F, Frigo AC, Suppiej A, Sainati L, Azzolina D, Agostini M, Cesaroni E, De Carlo L, Di Rosa G, Esposito G, Grazian L, Morini G, Nicita F, Operto FF, Pruna D, Ragazzi P, Rollo M, Spalice A, Striano P, Skabar A, Lanterna LA, Carai A, Marras CE, Manara R, Sartori S. Pediatric moyamoyadisease and syndrome in Italy:amulticentercohort[J]. Front Pediatr, 2022, 10:892445.
[16] Jin SC, Oh CW, Kwon OK, Hwang G, Bang JS, Kang HS, Kim JE, Lee SH, Chung YS. Epilepsy after bypass surgery in adult moyamoya disease[J]. Neurosurgery, 2011, 68:1227-1232.
[17] Uchino H, Kuroda S, Hirata K, Shiga T, Houkin K, Tamaki N. Predictors and clinical features of postoperative hyperperfusion after surgical revascularization for moyamoya disease:a serial single photon emission CT/positron emission tomography study[J]. Stroke, 2012, 43:2610-2616.
[18] Li CW, Zhang N, Xia CY. Recent advance in common complications and management after revascularization of moyamoya disease[J]. Zhonghua Shen Jing Yi Xue Za Zhi, 2019, 10:1060-1064.[李昌文, 张楠, 夏成雨. 烟雾病脑血流重建术后常见并发症及其处理的研究进展[J]. 中华神经医学杂志, 2019, 10:1060-1064.]
[19] Funaki T, Takahashi JC, Takagi Y, Kikuchi T, Yoshida K, Mitsuhara T, Kataoka H, Okada T, Fushimi Y, Miyamoto S. Unstable moyamoya disease:clinical features and impact on perioperative ischemic complications[J]. J Neurosurg, 2015, 122:400-407.
[20] Ivens S, Kaufer D, Flores LP, Bechmann I, Zumsteg D, Tomkins O, Seiffert E, Heinemann U, Friedman A. TGF-beta receptor-mediated albumin uptake into astrocytes is involved in neocortical epileptogenesis[J]. Brain, 2007, 130(Pt 2):535-547.
[21] Yu J, Zhang J, Li J, Zhang J, Chen J. Cerebral hyperperfusion syndrome after revascularization surgery in patients with moyamoya disease:systematic review and meta-analysis[J]. World Neurosurg, 2020, 135:357-366.e4.
[22] Edwards AM, Birchler CR, Park S, Baker JM, Molnar RG. Cerebral hyperperfusion syndrome presenting as status epilepticus following carotid endarterectomy[J]. Cureus, 2021, 13:e20551.
[23] Okuda S, Takano S, Ueno M, Hamaguchi H, Kanda F. Clinical features of late-onset poststroke seizures[J]. J Stroke Cerebrovasc Dis, 2012, 21:583-586.
[24] Ryvlin P, Montavont A, Nighoghossian N. Optimizing therapy of seizures in stroke patients[J]. Neurology, 2006, 67(12 Suppl 4):S3-9.
[25] Li ZX, Wang CX, Wang YL, Li LZ, Zhao XQ, Shao XQ, Wang CJ, Pan YS, Wang YJ. Incidence and influencing factors of the symptomatic seizure after spontaneous supratentorial intracerebral hemorrhage[J]. Zhongguo Zu Zhong Za Zhi, 2015, 10:298-305.[李子孝, 王春雪, 王伊龙, 李林子, 赵性泉, 邵晓秋, 王春娟, 潘岳松, 王拥军. 幕上自发性脑出血患者痫性发作的发生率及其相关因素分析——来自中国国家卒中登记数据库[J]. 中国卒中杂志, 2015, 10:298-305.]
[26] Zöllner JP, Schmitt FC, Rosenow F, Kohlhase K, Seiler A, Strzelczyk A, Stefan H. Seizures and epilepsy in patients with ischaemic stroke[J]. Neurol Res Pract, 2021, 3:63.
[27] Wall J, Knight J, Emsley HCA. Late-onset epilepsy predicts stroke:systematic review and meta-analysis[J]. Epilepsy Behav, 2021, 115:107634.

选择文件类型/文献管理软件名称

选择包含的内容

2 成人烟雾病联合血管重建术后癫痫发作特点及危险因素分析

Analysis of risk factors for epileptic seizure after combined revascularization in adult patients with moyamoya disease

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	张晨, 张延铭, 佟小光. 内镜下经鼻入路联合显微镜下开颅手术治疗复杂鼻颅沟通颅底肿瘤初探[J]. 中国现代神经疾病杂志, 2023, 23(7): 575-579.
[2]	贾亮, 周航, 张晓炜, 张庆九, 吕中强. 内镜下扩大经鼻入路手术切除鞍上侵袭性垂体腺瘤[J]. 中国现代神经疾病杂志, 2023, 23(7): 586-590.
[3]	冯珊珊. 基于危险因素的库欣病患者视力视野客观检查卫生经济学分析[J]. 中国现代神经疾病杂志, 2023, 23(7): 613-620.
[4]	邹婷婷, 马莉, 潘文静, 李长秀, 胡乃霞, 王擂. 重型颅脑创伤并发颅内感染危险因素分析及列线图预测模型构建[J]. 中国现代神经疾病杂志, 2023, 23(6): 496-502.
[5]	张檀, 丁钰, 袁利群. 直视下经皮扩张气管切开术在神经外科重症患者中的应用[J]. 中国现代神经疾病杂志, 2023, 23(6): 503-508.
[6]	刘臣超, 刘慧权, 袁小勇, 王健, 陈绅, 王义义, 柳兴军. 重症结核性脑膜炎预后不良影响因素分析[J]. 中国现代神经疾病杂志, 2023, 23(6): 522-529.
[7]	韩国庆, 蒲珂, 李庆国. 儿童脑海绵状血管瘤临床特点及发病机制研究进展[J]. 中国现代神经疾病杂志, 2023, 23(5): 393-397.
[8]	郭中印, 彭鹏, 陈籽荣, 张晓琳, 董民海, 曾括, 万丽君, 向网, 万锋. 幕上肿瘤患儿手术后行脑室-腹腔分流术危险因素分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 412-417.
[9]	彭小娇, 葛明, 吴迪, 蔡英杰, 陈佳树, 梁琛. 单中心儿童颅咽管瘤手术后下丘脑性肥胖危险因素分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 418-424.
[10]	李慧敏, 耿雨梅, 王梦莹, 王珊珊, 周青, 康慧聪. 伴中央颞区棘波的儿童自限性癫痫临床特征及共病分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 447-453.
[11]	邹鹏, 罗鹏, 张昊阜子, 刘剑, 程光, 蒋晓帆. 脑胶质瘤清醒麻醉术中癫痫发作对术后情绪及肌力的影响[J]. 中国现代神经疾病杂志, 2023, 23(5): 454-459.
[12]	冯增伟, 丁平, 廖先文, 焦永辉, 左云龙, 韩宏彦. 烟雾病脑血管重建术后发生脑过度灌注综合征的临床分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 460-466.
[13]	张旭, 王湘庆. 癫痫与皮质扩散性抑制相关性研究进展[J]. 中国现代神经疾病杂志, 2023, 23(5): 467-471.
[14]	余彩遥, 叶兰, 冯占辉. 癫痫患者认知功能障碍相关危险因素研究进展[J]. 中国现代神经疾病杂志, 2023, 23(4): 287-291.
[15]	孙艳, 范茹雪, 陈慧丰, 尹洁, 张楠. 天津市部分城市社区老年人群轻度认知损害患病情况及影响因素分析[J]. 中国现代神经疾病杂志, 2023, 23(4): 303-309.

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

2 成人烟雾病联合血管重建术后癫痫发作特点及危险因素分析

Analysis of risk factors for epileptic seizure after combined revascularization in adult patients with moyamoya disease

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价