The purpose of our research was to compere the course structural epilepsy, which is both the only manifestation of malformation and the debut of the disease in combination with intracerebral hemorrhage in patients (pts) with arteriovenous malformations (AVM) after endovascular and combined treatment using the Engel scale. The study is retrospective, non-randomized.
Material and Methods The study included patients with confirmed cerebral AVM by cerebral angiography data with concomitant epileptic seizures (both the only manifestation of the malformation and in combination with hemorrhage at the onset of the disease). The study took into account demographic characteristics (gender, age), AVM localization. Complications (mortality, disability) were assessed at each stage of treatment. The follow-up period average 3.5 years (range 1 to 7 years). All patients underwent endovascular embolization (EVE) at the first stage. In order to achieve total exclusion of the AVM from the bloodstream, in the absence of afferents available for embolization, further microsurgical (MS) or radiation (SRS) treatment was performed.
Results A total of 301 patients with cerebral arteriovenous malformations with concomitant epileptic seizures were treated. Of these, 246 pts (81,7%) had only seizure and 55 pts (18,3%) had a combined type (hemorrhage and seizures at the onset of the disease). The gender distribution was as follows: 169 men’s and 132 women’s, average age 37 years (from 6 to 69 years). According to the Spitzler Martin gradation, the distribution of patients was as follows: I - 11 (3,7%) pts, II - 63 (20,9%), III - 126 (41,9%), IV - 68 (22,6%), V - 33 (10,9%). Out of 301 pts, 150 (49,8%) achieved total exclusion of the AVM, subtotal (90% or more) in 23 pts (7,6%), partial - 128 pts (46,6%). The distribution by treatment methods in total obliterated AVMs was as follows: EVE+MS 42 pts (28%); EVE+SRS 31 pts (20,7%); EVE 77 pts (51,3%). The distribution of patients according to the Engel scale (class 1) in patients with epileptic and combined (hemorrhage and epileptic seizures) type of malformation course after total shutdown is presented in the table below:
From 2009 to 2022 years, 301 pts with cerebral AVMs and seizures were treated. Complications were received: 1 death (0,3%), 2 pts (0,6%) with severe neurological deficit and 12 pts (3,9%) with incomplete recovery after surgery. Control over seizures is directly proportional to the volume of the malformation turned off.
Conclusion The treatment of structural epilepsy in patients with cerebral AVMs should include all available surgical methods to freedom from seizures in order to improve the quality of life of patients. The method of endovascular embolization is minimally invasive and effective method of treatment in the control of seizures in patients with AVM.
Disclosures K. Orlov: None. A. Brusyanskaya: None. V. Berestov: None.