Surgical treatment of symptomatic epilepsy in patients with brain cavernomas
Keywords:symptomatic epilepsy, brain cavernoma, topectomy
Introduction. Epileptic seizures are one of the most common clinical manifestations of brain cavernomas. The purpose of study is to assess the efficiency of symptomatic epilepsy surgical treatment in patients with cerebral cavernomas.
Methods. The study included 22 patients with brain cavernomas caused symptomatic epilepsy. Patients were divided on two groups: I group consists 8 patients with cavernomas in the temporal lobe, II group consists 14 patients with extratemporal lesion’s localization. In all patients microsurgical resection of cavernomas was performed, 3 patients underwent additional anterior temporal lobectomy. Follow-up was from 10 months to 3,5 years.
Results. In I group 5 (62.5%) patients became seizure-free or have rare seizures, in 3 (37,5%) cases seizure frequency reduced slightly or did not change. Control for seizures was most effective in patients who underwent topectomy with additional anterior temporal lobectomy. In group II seizure control or significant seizure reduction was achieved in 7 (50%) patients, in other 7 (50%) — seizure frequency reduced slightly or did not change.Conclusion. Surgical strategy of patients with symptomatic epilepsy associated with cavernomas should focus on the lesion resection with additional excision of the hemosiderin-stained tissue. In temporal cavernomas such surgery should be supplemented by anterior temporal lobectomy.
1. Voigt K, Yaşargil MG. Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case. Neurochirurgia (Stuttg). 1976 Mar;19(2):59-68. [PubMed]
4. Bertalanffy H, Benes L, Miyazawa T, Alberti O, Siegel A, Sure U. Cerebral cavernomas in the adult: review of the literature and analysis of 72 surgically treated patients. Neurosurg Rev. 2002;25(1-2):1-53. [CrossRef] [PubMed]
5. Siegel A, Andermann E, Badhwar A, Rouleau G, Wolford G, Andermann F, Hess K. Anticipation in familial cavernous angioma: a study of 52 families from International Familial Cavernous Angioma Study. The Lancet. 1998;352(9141):1676-7. [CrossRef]
6. Lobato R, Perez C, Rivas J, Cordobes F. Clinical, radiological, and pathological spectrum of angiographically occult intracranial vascular malformations. J Neurosurg. 1988;68(4):518-31. [CrossRef] [PubMed]
8. Menzler K, Chen X, Thiel P, Iwinska-Zelder J, Miller D, Reuss A, Hamer HM, Reis J, Pagenstecher A, Knake S, Bertalanffy H, Rosenow F, Sure U. Epileptogenicity of cavernomas depends on (archi-) cortical localization. Neurosurgery. 2010;67(4):918-24. [CrossRef] [PubMed]
9. Menzler, K., Thiel, P., Hermsen, A., Chen, X., Benes, L., Miller, D., Sure, U., Knake, S. and Rosenow, F. The role of underlying structural cause for epilepsy classification: Clinical features and prognosis in mesial temporal lobe epilepsy caused by hippocampal sclerosis versus cavernoma. Epilepsia. 2011;52(4):707-711. [CrossRef]
10. Josephson C, Leach J, Duncan R, Roberts R, Counsell C, Al-Shahi Salman R. Seizure risk from cavernous or arteriovenous malformations: Prospective population-based study. Neurology. 2011;76(18):1548-54. [CrossRef] [PubMed]
13. Kim W, Stramotas S, Choy W, Dye J, Nagasawa D, Yang I. Prognostic factors for post-operative seizure outcomes after cavernous malformation treatment. J Clin Neurosci. 2011;18(7):877-80. [CrossRef] [PubMed]
14. Baumann C, Acciarri N, Bertalanffy H Devinsky O, Elger CE, Lo Russo G, Cossu M, Sure U, Singh A, Stefan H, Hammen T, Georgiadis D, Baumgartner RW, Andermann F, Siegel AM. Seizure Outcome after Resection of Supratentorial Cavernous Malformations: A Study of 168 Patients. Epilepsia. 2007;48(3):559-63. [CrossRef] [PubMed]
15. Stavrou I, Baumgartner C, Frischer J, Trattnig S, Knosp E. Long-term seizure control after resection of supratentorial cavernomas: a retrospective single-center study in 53 patients Neurosurgery. 2008;63(5):888-97. [CrossRef] [PubMed]
16. Chang E, Gabriel R, Potts M, Garcia P, Barbaro N, Lawton M. Seizure characteristics and control after microsurgical resection of supratentorial cerebral cavernous malformations Neurosurgery. 2009;65(1):31-8. [CrossRef] [PubMed]
17. Yeon J, Kim J, Choi S, Seo D, Hong S, Hong S. Supratentorial cavernous angiomas presenting with seizures: Surgical outcomes in 60 consecutive patients. Seizure. 2009;18(1):14-20. [CrossRef] [PubMed]
18. Wieser H, Blume W, Fish D e Goldensohn E, Hufnagel A, King D, Sperling MR, Lüders H, Pedley TA; Commission on Neurosurgery of the International League Against Epilepsy (ILAE). Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia. 2001;42(2):282-286. [CrossRef] [PubMed]
19. Mintser OP, Voronenko YuV, Vlasov VV. Obroblennya klinichnykh i eksperymentalʹnykh danykh u medytsyni: navch. posibnyk [Treatment of clinical and experimental data in medicine; a tutorial]. Kiev: Vyshcha shkola; 2003. Ukrainian.
21. Van Gompel J, Marsh W, Meyer F, Worrell G. Patient-assessed satisfaction and outcome after microsurgical resection of cavernomas causing epilepsy. Neurosurg Focus. 2010;29(3):E16. [CrossRef]
23. Van Gompel J, Rubio J, Cascino G, Worrell G, Meyer F. Electrocorticography-guided resection of temporal cavernoma: is electrocorticography warranted and does it alter the surgical approach? J Neurosurg. 2009;110(6):1179-85. [CrossRef] [PubMed]
25. Regis J, Bartolomei F, Kida Y, Kobayashi T, Vladyka V, Liscàk R, Forster D, Kemeny A, Schröttner O, Pendl G. Radiosurgery for epilepsy associated with cavernous malformation: retrospective study in 49 patients. Neurosurgery. 2000;47(5):1091-7. [CrossRef] [PubMed]
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