Cavernoma-related epilepsy in cavernous malformations located within the temporal lobe: surgical management and seizure outcome

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Cavernoma-related epilepsy (CRE) is a frequent symptom in patients with cerebral cavernous malformations (CCMs). Reports on surgical management and seizure outcome of epileptogenic CCM often focus on intracranial cavernoma in general. Therefore, data on CCMs within the temporal lobe are scarce. The authors therefore analyzed their institutional data.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>From 2003 to 2018, 52 patients suffering from CCMs located within the temporal lobe underwent surgery for CRE at University Hospital Bonn. Information on patient characteristics, preoperative seizure history, preoperative evaluation, surgical strategies, postoperative complications, and seizure outcome was assessed and further analyzed. Seizure outcome was assessed 12 months after surgery according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class I) versus unfavorable (ILAE classes II–VI).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Overall, 47 (90%) of 52 patients with CCMs located in the temporal lobe and CRE achieved favorable seizure outcome. Pure lesionectomy was performed in 5 patients, extended lesionectomy with resection of the hemosiderin rim in 38 patients, and anterior temporal lobectomy in 9 patients with temporal lobe CCM. Specifically, 36 patients (69%) suffered from drug-resistant epilepsy (DRE), 3 patients (6%) from chronic CRE, and 13 patients (25%) sustained sporadic CRE. In patients with DRE, favorable seizure outcome was achieved in 32 (89%) of 36 patients. Patients with DRE were significantly older than patients with CCM-associated chronic or sporadic seizures (p = 0.02). Furthermore, patients with DRE more often underwent additional amygdalohippocampectomy following the recommendation of presurgical epileptological evaluation.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Favorable seizure outcome is achievable in a substantial number of patients with epileptogenic CCM located in the temporal lobe, even if patients suffered from drug-resistant CRE. For adequate counseling and monitoring, patients with CRE should undergo a thorough pre- and postsurgical evaluation in dedicated epilepsy surgery programs.</jats:p></jats:sec>

Quality of life and mood assessment in conservatively treated cavernous malformation‐related epilepsy

“…Since treatment is often personalized, particularly in the case of CRE, patients and surgeons often face the difficult question of whether to opt for surgery or continue drug treatment (Dammann et al., 2021 ). Recently published data have highlighted the value of open and minimally invasive surgery for epileptogenic CCM lesions, including pediatric and adult patients (Dammann, Wrede, et al., 2017 ; Kapadia et al., 2021 ; Lee et al., 2017 ; Lin et al., 2018 ; Ozlen et al., 2021 ; Satzer et al., 2020 ; Schuss et al., 2020 ; Willie et al., 2019 ). Nevertheless, although early CCM removal is often feasible and effective, this topic is still a matter of debate, and high‐quality evidence‐based recommendations are missing (Awad & Polster, 2019 ; Zanello et al., 2019 ).…”

MR-Imaging and Histopathological Diagnostic Work-Up of Patients with Spontaneous Lobar Intracerebral Hemorrhage: Results of an Institutional Prospective Registry Study

“…In patients with cerebellar ICH, suboccipital DC with or without ICH evacuation was performed if neurological deterioration and/or radiological signs of acute hydrocephalus occurred [ 20 ]. In subsequent treatment of the pathologies underlying the lobar ICH, the established guidelines were followed as previously reported [ 12 , 21 , 22 ].…”

Clinical characteristics and long‐term outcome of cerebral cavernous malformations‐related epilepsy

“…Small population sizes and insufficient length of follow-up further limited the contribution of these studies to clinical management. [11][12][13][14][15][19][20][21] With the use of magnetic resonance imaging (MRI), the prevalence of CCM diagnosis has increased. Therefore, it is crucial to identify the clinical and imaging markers of epileptogenic CCMs, particularly those that lead to refractory seizures.…”

“…Many of the available statistical findings were confined to surgically treated patients or those with single lesions. Small population sizes and insufficient length of follow‐up further limited the contribution of these studies to clinical management 11–15,19–21 …”