Radiosurgery for Epilepsy Associated with Cavernous Malformation: Retrospective Study in 49 Patients

Abstract

This series is the first to specifically evaluate the capability of GK surgery to safely and efficiently treat epilepsy associated with CM. Seizure control can be reached when a good electroclinical correlation exists between CM location and epileptogenic zone. Although we do not recommend GK surgery for prevention of bleeding for a CM that has not bled previously, our findings suggest that GK surgery can be proposed for the treatment of epilepsy when the CM is located in a highly functional area.

Radiosurgery for angiographically occult vascular malformations

“…Patients with simple partial seizures also had better outcomes than those presenting with complex partial seizures. 49 Surgical removal is considered the best treatment for patients with intractable seizures. Cappabianca et al 7 have shown that from among a series of 35 patients with solitary supratentorial CMs, 29 became seizure free (83%) after lesionectomy.…”

“…Of the 3 largest studies conducted by Liscák et al, 35 Liu et al, 37 and Ré-gis et al, 49 only Liscák et al reported increased seizure frequency in 2 of 44 patients due to transient radiationinduced edema. In a study of 28 patients, Zhang et al 67 described 6 patients whose seizures increased in frequency.…”

“…In a study on the radiosurgical treatment of AEDresistant epilepsy caused by AOVMs in 49 patients, Régis et al 49 described a seizure-free outcome in 53% of pa- tients and a reduction in seizures in an additional 20%. Although the authors treated lesions located in both cortical and subcortical structures, they found that the probability of becoming seizure free was significantly higher if a patient's lesion had an extratemporal location.…”

Stereotactic radiosurgery for treatment of drug-resistant epilepsy: state of the art and emerging applications

“…A cavernous malformation (CM) is a congenital vascular abnormality that can cause haemorrhage or neurological deficit but more commonly manifests as recurring seizures [54][55]. Although open microsurgical treatment of CM remains the standard efficacious therapy, a recent study by Regis, et al suggested a role for radiosurgery in the treatment of seizures associated with CM near the "highly functional cortex", a location that may preclude open resection [54].…”

“…Although open microsurgical treatment of CM remains the standard efficacious therapy, a recent study by Regis, et al suggested a role for radiosurgery in the treatment of seizures associated with CM near the "highly functional cortex", a location that may preclude open resection [54]. Using a mean dose of 19 Gy, 53% of 49 patients with refractory seizures became seizure-free and 20% of treated ones improved at two years [54]. These results demonstrate that epilepsy associated with CM located near the eloquent cortex may be treated with radiosurgery to reduce seizure frequency.…”