Long-Term Seizure Control After Resection of Supratentorial Cavernomas

Stavrou, Ioannis; Baumgartner, Christoph; Frischer, Josa M.; Trattnig, Siegfried; Knosp, Engelbert

doi:10.1227/01.neu.0000327881.72964.6e

Cited by 89 publications

(91 citation statements)

References 30 publications

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“…However, the definition of chronic and refractory epilepsy remains controversial. Some authors considered 2 years of medical management as the cut-off for accurate classification [38]. In our series, preoperative seizure duration was not statistically significant of seizure control, neither when dichotomized in less than or more than 18 months, nor when evaluated as a continuous variable.…”

Section: Disease Durationcontrasting

confidence: 51%

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Temporal lobe epilepsy and cavernous malformations: surgical strategies and long-term outcomes

et al. 2015

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Patients with temporal lobe CCM should be offered resection for durable seizure control, prevention of secondary epileptogenic foci, and elimination of hemorrhage risk. The preoperative work-up should follow a team approach. Surgical intervention should include complete lesionectomy in all cases. Intra or extra-operative ECoG for neocortical lesions may be beneficial. Management of mesial temporal CCMs (archicortex) should consider resection of a well-defined epileptogenic zone (including mesial structures) due to high probability of pathologically proven MTS. The use of this treatment algorithm is useful for the education and treatment of these patients.

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Section: Disease Durationcontrasting

confidence: 51%

“…There is enough clinical data that support the benefit of surgical intervention in CCM and epilepsy. Most authors report greater than 80 % seizure control with surgery [17,26,38,45]. It is noteworthy that 10-20 % of all CCM can occur in the temporal lobe [25].…”

Section: Introductionmentioning

confidence: 99%

Temporal lobe epilepsy and cavernous malformations: surgical strategies and long-term outcomes

et al. 2015

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“…Ilgalaikio neurologinio sutrikimo dažnis siekia 2,6-8 %. Tai sudaro tokius simptomus, kaip stiprus galvos skausmas, kalbos sutrikimas, jutimų sutrikimas, ataksija, sunki hemiparezė [10][11][12].…”

Section: Klinikaunclassified

Galvos smegenų kaverninė malformacija

Beržanskis¹,

Macytė²,

Šustickas³

2017

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Galvos smegenų kaverninė malformacija (KM, kavernoma, kaverninė angioma, kaverninė hemangioma) -tai įgimtas krauja gyslinis darinys, sudarytas iš kompaktiškai išsidėsčiusio išsiplėtusių kapiliarų rezginio, kuriame nėra smegenų parenchimos. Dažnai kavernomų simptomatikos pasireiškimas susijęs su pakraujavimu. Tačiau kavernomos gali būti besimptomės, jos nu statomos atsitiktinai. Kasmetinis kamieno kavernomų pakraujavimo dažnis -nuo 2,3 % iki 4,1 %.Todėl dauguma sunkių ži dinių tampa neurochirurgijos centrų tikslu. Giliai esančių bei kamieno židinių chirurgija yra ne tokia sėkminga. Kavernomų simptomatika priklauso nuo židinio lokalizacijos. Apie 80 % atvejų kavernomos yra viršdangtinės. Dažniausiai pažeidžiamos kaktinė bei smilkininė skiltys, požievinė zona. Būdingiausi simptomai yra epilepsija ir traukuliai. Šie simptomai yra susiję su kaverninės malformacijos pakraujavimu. Renkantis chirurginį gydymą svarbu įvertinti židinio anatomiją ir lokalizaciją atlikus magnetinio rezonanso tomografiją (MRT). Radikalus kavernomos chirurginis pašalinimas yra vienintelis veiksmingas gydymo metodas.MRT yra jautriausias ir specifiškiausias kavernomų diagnostikos metodas. Mažas kavernomas rutininiu MRT gali būti sunku diagnozuoti. Reikšminiai žodžiai: Galvos smegenų kaverninė malformacija, kavernoma, kaverninė angioma, kaverninė hemangioma Cerebral cavernous malformations (CCM) are lowflow vascular lesions in eloquent locations. Their presentation is often marked with symptomatic hemorrhages. Annual brainstem CM rate of hemorrhage is from 2.3% to 4.1%. Surgery for deepseated or brainstem lesions is less successful and is associated with an early morbidity rate of roughly 30-70% and a mortality rate of 2%. Signs and symptoms of CCM depends on localization in the brain. Approximately 80% of cases are supratentorial caverno mas. The most frequent injuring zones are frontal, temporal lobes and subcortical region. The most common symptoms are epilepsy and seizures. Also it can effect motor fibers which are situated in the cerebellum branch. Statistically approximately 40% all of CCM are asymptomatic and found accidentally when radiological investigations are taken.

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“…3,9,28,33 Fortunately, at follow-up the rate of severe permanent neurological deficits descends to 2.6%-8%. 3,4,9,10,12,15,28,32,33 Our strategy employing FN and iopMRI only led to two mild (7.7%) and one moderate (3.8%) permanent visual field deficit, while the rate of post-surgical general complications was 7.7% and severe neurological deficits did not occur at all.…”

Section: 32mentioning

confidence: 99%

Surgical management of epilepsy due to cerebral cavernomas using neuronavigation and intraoperative MR imaging

Sommer¹,

Kasper²,

Coras³

et al. 2013

Neurological Research

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Objectives: Cure from seizures due to cavernomas might be surgically achieved dependent on both, the complete removal of the cavernoma as well as its surrounding hemosiderin rim. High field intraoperative MRI imaging (iopMRI) and neuronavigation might play a crucial role to achieve both goals. We retrospectively investigated the long-term results and impact of intraoperative 1.5T MRI (iopMRI) and neuronavigation on the completeness of surgical removal of a cavernous malformation (CM) and its perilesional hemosiderin rim as well as reduction of surgical morbidity. Methods: 26 patients (14 female, 12 male, mean age 39.1 years, range: 17-63 years) with CM related epilepsy were identified. Eighteen patients suffered from drug resistant epilepsy (69.2%). Mean duration of epilepsy was 11.9 years in subjects with drug resistant epilepsy (n 5 18) and 0.3 years in subjects presenting with first-time seizures (n 5 8). We performed 24 lesionectomies and two lesionectomies combined with extended temporal resections. Seven lesions were located extratemporally. Results: Complete CM removal was documented by postsurgical MRI in all patients. As direct consequence of iopMRI, refined surgery was necessary in 11.5% of patients to achieve complete cavernoma removal and in another 11.5% for complete resection of additional adjacent epileptogenic cortex. Removal of the hemosiderin rim was confirmed by iopMRI in 92% of patients. Two patients suffered from mild (7.7%) and one from moderate (3.8%) visual field deficits. Complete seizure control (Engel class 1A) was achieved in 80.8% of patients with a mean follow-up period of 47.7 months. Discussion: We report excellent long-term seizure control with minimal surgical morbidity after complete resection of CM using our multimodal approach.

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Long-Term Seizure Control After Resection of Supratentorial Cavernomas

Abstract: In a long-term follow-up period, 84.9% of the patients in the study could be evaluated as Engel Class I. The analysis of outcome showed that patients benefited significantly from early surgery and excision of the hemosiderin rim.

Cited by 89 publications

References 30 publications

Temporal lobe epilepsy and cavernous malformations: surgical strategies and long-term outcomes

Temporal lobe epilepsy and cavernous malformations: surgical strategies and long-term outcomes

Galvos smegenų kaverninė malformacija

Surgical management of epilepsy due to cerebral cavernomas using neuronavigation and intraoperative MR imaging

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