脑膜血管瘤病伴癫痫的临床特点分析

目的总结脑膜血管瘤病的临床特点、治疗经验及预后。方法回顾性分析广东三九脑科医院2016年6月—2021年1月期间收治的6例脑膜血管瘤病患者的临床资料，并结合相关文献进行复习。结果6例患者中，临床发作表现为全身强直阵挛发作1例，部分发作继发全身强直阵挛发作5例。术中皮层监测提示所有患者病变部位有癫痫样放电，均在术中皮层脑电图监测引导下行病灶＋病灶周围皮层致痫灶切除手术治疗。术后均给予抗癫痫药物治疗，术后Engel分级均为Ⅰ级，术后近期及远期均无明显并发症出现。结论反复癫痫发作的患者，如果颅脑MRI提示长T1长T2异常信号影，T2 Flair呈内低外高信号影，T1增强可见部分强化，CT扫描提示，钙化病变应考虑脑膜血管瘤病的诊断可能。脑膜血管瘤病经过电生理评估和多学科讨论确定致痫区后，给予病灶和周围致痫区切除术，手术疗效好，术后复发风险低，所以脑膜血管瘤病伴癫痫患者可通过手术获得良好受益，早期手术受益远远大于风险。

Objective To summarize the clinical features, treatment experience and prognosis of meningeal hemangioma. Methods The clinical data of 6 patients with meningeal hemangioma and meningiomatosis admitted to Guangdong Sanjiu Brain Hospital from June 2016 to January 2021 were analyzed retrospectively, and the relevant literature was reviewed. Results Among the 6 patients, 1 manifested generalized tonic-clonic seizures and 5 were partial seizures secondary to generalized tonic-clonic seizures. Epileptic discharges were found at the lesion site during intraoperative cortical monitoring. All patients were treated with the gross-total resection of the lesion and the surrounding cortex under the guide of intraoperative monitoring . Anti-epileptic drugs were given regularly after operation and no patient died or suffered a permanent defcit after surgery. Postoperatively, all the patients were seizure free. Conclusions In patients with recurrent seizures, if the brain MRI shows long abnormal signal in T1 and T2 weighted sequence, especially low signal inside and high signal outside in T2 Flair sequence, T1 weighted enhancement can be enhanced without visible part, and CT scans show calcified lesions, the diagnosis of meningeal hemangioma should be considered. After electrophysiological evaluation and multidisciplinary discussion to determine the epileptic zone for meningeal hemangioma, the focus and surrounding tissues are removed. The outcomes are good, and the risk of postoperative recurrence is low. Therefore, patients of meningeal hemangioma with epilepsy can be treated with surgery, especially in early stage.