Tratamento cirúrgico das patologias vasculares cerebrais nos pacientes epilépticos

Rassi-Neto, Aziz; Ribeiro, Paulo R. Jubé; Prates, Marcello Americano; Muszkat, Mauro; Campos, Carlos José Reis de; Ferraz, Fernando A. P.

doi:10.1590/S0004-282X1997000300009

Resumos

A cirurgia das malformações arteriovenosas (MAV) e dos cavernomas (angioma cavernoso) na maioria das vezes é indicada após episódios de sangramento. Com o desenvolvimento das técnicas de diagnóstico e cirúrgicas na epilepsia de difícil controle, passou a ser cada vez maior a indicação cirúrgica destas lesões vasculares. Apresentamos nove pacientes com lesões vasculares cerebrais e crises muito frequentes, apesar do tratamento clínico adequado. A faixa etária variou de 12 a 42 anos de idade, com média de 25 anos; houve prevalência no sexo masculino (2:1). A cirurgia consistiu na exérese da lesão em todos os casos. Em quatro casos houve também ressecção da área irritativa perilesional, que foi demostrada pela eletrocorticografia. O estudo anatomopatológico das lesões mostrou cinco casos de cavernoma, três de MAV e um de angioma venoso. Quanto à localização, observamos três lesões no lobo temporal, quatro no frontal e duas na região parietal. O acompanhamento ambulatorial mostrou redução das crises em todos os pacientes, sendo que sete evoluíram sem crises após a cirurgia.

epilepsia; crises epilépticas; cirurgia; angioma cavernoso; malformação arteriovenosa

Surgery of arteriovenous malformations (AVM) and of cavernous angiomas (cavernoma) in the majority of cases is indicated subsequently to episodes of bleeding. With the development of techniques for diagnosis and surgery for epilepsy of difficult control, indication for surgery of these vascular lesions has become greater. We present nine patients with cerebral vascular lesions and very frequent crises in spite of adequate clinical treatment. Ages ranged from 12 to 42 years with an average of 25 years; there was a prevalence of the male sex (2:1). Surgery consisted of exeresis of the lesion in all cases and in four there was also resection of the perilesional irritative area shown by electrocorticography. The pathologic study of lesions showed five cases of cavernoma, three cases of AVM, and one case of venous angioma. As to localization, we observed three lesions in the temporal lobe, four in the frontal, and two in the parietal region. Outpatient follow-up showed a reduction in crises in all of the patients, and seven evolved seizure free following surgery.

epilepsy; epileptic seizures; surgery; cavernous angioma; arteriovenous malfomations

Tratamento cirúrgico das patologias vasculares cerebrais nos pacientes epilépticos

Surgical treatment of cerebral vascular pathologies in epiletic patients

Aziz Rassi-Neto; Paulo R. Jubé Ribeiro; Marcello Americano Prates; Mauro Muszkat; Carlos José Reis de Campos; Fernando A. P. Ferraz

Departamento de Neurologia e Neurocirurgia da Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM)

RESUMO

A cirurgia das malformações arteriovenosas (MAV) e dos cavernomas (angioma cavernoso) na maioria das vezes é indicada após episódios de sangramento. Com o desenvolvimento das técnicas de diagnóstico e cirúrgicas na epilepsia de difícil controle, passou a ser cada vez maior a indicação cirúrgica destas lesões vasculares. Apresentamos nove pacientes com lesões vasculares cerebrais e crises muito frequentes, apesar do tratamento clínico adequado. A faixa etária variou de 12 a 42 anos de idade, com média de 25 anos; houve prevalência no sexo masculino (2:1). A cirurgia consistiu na exérese da lesão em todos os casos. Em quatro casos houve também ressecção da área irritativa perilesional, que foi demostrada pela eletrocorticografia. O estudo anatomopatológico das lesões mostrou cinco casos de cavernoma, três de MAV e um de angioma venoso. Quanto à localização, observamos três lesões no lobo temporal, quatro no frontal e duas na região parietal. O acompanhamento ambulatorial mostrou redução das crises em todos os pacientes, sendo que sete evoluíram sem crises após a cirurgia.

Palavras-chave: epilepsia, crises epilépticas, cirurgia, angioma cavernoso, malformação arteriovenosa.

ABSTRAT

Surgery of arteriovenous malformations (AVM) and of cavernous angiomas (cavernoma) in the majority of cases is indicated subsequently to episodes of bleeding. With the development of techniques for diagnosis and surgery for epilepsy of difficult control, indication for surgery of these vascular lesions has become greater. We present nine patients with cerebral vascular lesions and very frequent crises in spite of adequate clinical treatment. Ages ranged from 12 to 42 years with an average of 25 years; there was a prevalence of the male sex (2:1). Surgery consisted of exeresis of the lesion in all cases and in four there was also resection of the perilesional irritative area shown by electrocorticography. The pathologic study of lesions showed five cases of cavernoma, three cases of AVM, and one case of venous angioma. As to localization, we observed three lesions in the temporal lobe, four in the frontal, and two in the parietal region. Outpatient follow-up showed a reduction in crises in all of the patients, and seven evolved seizure free following surgery.

Key words: epilepsy, epileptic seizures, surgery, cavernous angioma, arteriovenous malfomations.

Texto completo disponível apenas em PDF.

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Aceite: 18-março-1997.

Dr. Aziz Rassi Neto - Rua Jacurici 129 apto 112 - 01453-030 São Paulo SP -Brasil.

1. Aiba T, Tanaka R, Koioke T, Kameyama S, Takeda N, Komota T. Natural history of cavernous malformations. J Neurosurg 1993;78:19-25.
2. Arseni C, Petrovici IN. Epilepsy in temporal lobe tumours. Eur Neurol 1971;5:201-214.
3. Boon PA, Williamson PD, Fried I, Spencer DD, Novelly RA, Spencer SS, Mattson RH. Intracranial, intraaxial, space occupying lesions in patients with intractable partial seizures: an anatomoclinical, neuropsychological, and surgica correlation. Epilepsia 1991;32:467-476.
4. Cheong WY, Tan KP. Cerebral venous angioma: a misnover? Ann Acad Med 1993;22:736-741.
5. Dodick WD, Cascino GD, Meyer FB. Vascular malformations and intractable epilepsy: outcome after surgical treatment Mayo Clin Proc 1994;69:742-745.
6. Franceschetti S, Binelli S, Casazza M, Lodrini S, Panzica F, Solero CL, Avanzini G. Influence of surgery and antiepilepti drugs on seizures symptomatic of cerebral tumors. Acta Neurochirurg (Wien) 1990;103:47-51.
7. Garner TG, Curling OD Jr, Kelly DL Jr, Laster DW. The natural history of intracranial venous angiomas. J Neurosurj 1991;75:715-722.
8. Gerszten PC, Adelson PD, Kondziolka D, Flickinger JC, Lunsford LD. Seizure outcome in children treated for arteriovenou malformations using gamma knife radiosurgery. Ped Neurosurg 1996;24:139-144.
9. Kamada K, Isu T, Takahashi T, Tanaka T. Remote epileptogenic focus detected by electrocorticogram in a case of cavernou angioma. Acta Neurochirurg (Wien) 1994;127:236-239.
10. Kirkpatrick PJ, Honavar M, Janota I, Polkey CE. Control of temporal lobe epilepsy following en bloc resection of low grade tumors. J Neurosurg 1993;78:19-25.
11. Millichap JG, Bickford RG, Miller RH, Backus RE. The eletroencephalogram in children with intracranial tumors am seizures. Neurology 1961;12:329-336.
12. Perret G, Nishioka H. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage: VI Arteriovenous malformations: an analysis of545 cases of cranio- cerebral arteriovenous malformations and fistulae reportei to the cooperative study. J Neurosurg 1966;25:467-490.
13. Piepgras DG, Sundt TM, Ragoowansi AT, Stevens L. Seizures outcome in patients with surgically treated cerebra arteriovenous malformations. J Neurosurg 1993;78:5-11.
14. Pozzati E, Padovani R, Morrone B, Finizio F, Gaist G. Cerebral cavernous angiomas in children. J Neurosurg 1980;53:826-832
15. Rasmussen T. Surgery of epilepsy associated with brain tumors. Adv Neurol 1975;8:227-239.
16. Sasaki O, Tanaka R, Koike T, Koide A, Koizumi T, Ogawa H. Excision of cavernous angioma with preservation of coexistinj venous angioma. J Neurosurg 1991;75:461-464.
17. Spetzler RF, Martin N. A proposed grading system for arteriovenous malformations. J Neurosurg 1986;65:476-483.
18. Yeh HS, Tew JM Jr, Gartner M. Seizure control after surgery on cerebral arteriovenous malformations. J Neurosurg 1993;78:12-18.

Datas de Publicação

Publicação nesta coleção
21 Out 2010
Data do Fascículo
Set 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Aiba T, Tanaka R, Koioke T, Kameyama S, Takeda N, Komota T. Natural history of cavernous malformations. J Neurosurg 1993;78:19-25.

[2] 2. Arseni C, Petrovici IN. Epilepsy in temporal lobe tumours. Eur Neurol 1971;5:201-214.

[3] 3. Boon PA, Williamson PD, Fried I, Spencer DD, Novelly RA, Spencer SS, Mattson RH. Intracranial, intraaxial, space occupying lesions in patients with intractable partial seizures: an anatomoclinical, neuropsychological, and surgica correlation. Epilepsia 1991;32:467-476.

[4] 4. Cheong WY, Tan KP. Cerebral venous angioma: a misnover? Ann Acad Med 1993;22:736-741.

[5] 5. Dodick WD, Cascino GD, Meyer FB. Vascular malformations and intractable epilepsy: outcome after surgical treatment Mayo Clin Proc 1994;69:742-745.

[6] 6. Franceschetti S, Binelli S, Casazza M, Lodrini S, Panzica F, Solero CL, Avanzini G. Influence of surgery and antiepilepti drugs on seizures symptomatic of cerebral tumors. Acta Neurochirurg (Wien) 1990;103:47-51.

[7] 7. Garner TG, Curling OD Jr, Kelly DL Jr, Laster DW. The natural history of intracranial venous angiomas. J Neurosurj 1991;75:715-722.

[8] 8. Gerszten PC, Adelson PD, Kondziolka D, Flickinger JC, Lunsford LD. Seizure outcome in children treated for arteriovenou malformations using gamma knife radiosurgery. Ped Neurosurg 1996;24:139-144.

[9] 9. Kamada K, Isu T, Takahashi T, Tanaka T. Remote epileptogenic focus detected by electrocorticogram in a case of cavernou angioma. Acta Neurochirurg (Wien) 1994;127:236-239.

[10] 10. Kirkpatrick PJ, Honavar M, Janota I, Polkey CE. Control of temporal lobe epilepsy following en bloc resection of low grade tumors. J Neurosurg 1993;78:19-25.

[11] 11. Millichap JG, Bickford RG, Miller RH, Backus RE. The eletroencephalogram in children with intracranial tumors am seizures. Neurology 1961;12:329-336.

[12] 12. Perret G, Nishioka H. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage: VI Arteriovenous malformations: an analysis of545 cases of cranio- cerebral arteriovenous malformations and fistulae reportei to the cooperative study. J Neurosurg 1966;25:467-490.

[13] 13. Piepgras DG, Sundt TM, Ragoowansi AT, Stevens L. Seizures outcome in patients with surgically treated cerebra arteriovenous malformations. J Neurosurg 1993;78:5-11.

[14] 14. Pozzati E, Padovani R, Morrone B, Finizio F, Gaist G. Cerebral cavernous angiomas in children. J Neurosurg 1980;53:826-832

[15] 15. Rasmussen T. Surgery of epilepsy associated with brain tumors. Adv Neurol 1975;8:227-239.

[16] 16. Sasaki O, Tanaka R, Koike T, Koide A, Koizumi T, Ogawa H. Excision of cavernous angioma with preservation of coexistinj venous angioma. J Neurosurg 1991;75:461-464.

[17] 17. Spetzler RF, Martin N. A proposed grading system for arteriovenous malformations. J Neurosurg 1986;65:476-483.

[18] 18. Yeh HS, Tew JM Jr, Gartner M. Seizure control after surgery on cerebral arteriovenous malformations. J Neurosurg 1993;78:12-18.