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首页> 外文期刊>Interdisciplinary Neurosurgery >Intractable epilepsy associated with angiographic obliteration of a medial temporal arteriovenous malformation following stereotactic radiosurgery
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Intractable epilepsy associated with angiographic obliteration of a medial temporal arteriovenous malformation following stereotactic radiosurgery

机译：立体定向放射外科治疗后颞内侧动静脉畸形的血管造影消失与顽固性癫痫

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摘要

We present a case with recurrence of intractable complex partial epilepsy, despite angiographic obliteration of a cerebral arteriovenous malformation in the left medial temporal lobe following gamma knife radiosurgery. Preoperative memory function was normal, with no evidence of hippocampal atrophy by magnetic resonance imaging. Intraoperative electrocorticography demonstrated two independent foci of paroxysmal activity in the lateral and medial temporal lobes. As preoperative magnetic resonance imaging demonstrated subcortical hyperintensity, the lateral temporal lobe was resected. Histologically, there was evidence of subcortical myelin pallor, likely resulting from ischemic damage associated with hemodynamic changes following radiosurgery. As there was a decrease in the frequency of paroxysmal discharges in the hippocampus following arteriovenous malformation nidus removal, the hippocampus was preserved. Histological examination of the nidus revealed that some of the vessels had patent lumina, while ischemia affecting the neighboring hippocampus was considered to show improvement. A good seizure outcome was obtained. In summary, perioperative multimodal examinations, including intraoperative electrocorticography, revealed various epileptogenic mechanisms, probably related to myelin pallor in the lateral temporal lobe and focal ischemia secondary to patent AVM in the medial temporal lobe, of this patient.
机译：我们提出了一个病例，尽管在伽玛刀放射治疗后左内侧颞叶脑动静脉畸形血管造影消失，但顽固性复杂的部分性癫痫复发。术前记忆功能正常，磁共振成像未见海马萎缩的迹象。术中皮质脑电图显示外侧和内侧颞叶有两个独立的阵发性活动灶。术前磁共振成像显示皮层下高，切除了颞颞叶。从组织学上看，存在皮层下髓鞘苍白的证据，可能是由放射外科手术后与血流动力学变化相关的缺血性损害所致。由于动静脉畸形nidus去除后海马阵发性放电的频率降低，因此海马得以保留。对病灶的组织学检查显示，某些血管有腔腔未闭，而影响邻近海马的缺血被认为有改善。癫痫发作良好。总之，围术期多模式检查，包括术中脑电图检查，揭示了该患者的各种致癫机制，可能与外侧颞叶的髓磷脂苍白和内侧颞叶继发于专利AVM的局灶性缺血有关。

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