Seizure Outcome after Resection of Supratentorial Cavernous Malformations: A Study of 168 Patients

Abstract

Summary: Purpose:The optimal management of cerebral cavernous malformations (CCMs) with epileptic seizures is still a matter of debate. The aim of our study was to examine seizure outcome in the largest published series of surgically treated patients with epilepsy due to a supratentorial CCM, and to define predictors for good surgical outcome.Methods: We retrospectively studied 168 consecutive patients with a single supratentorial CCM and symptomatic epilepsy in a multicenter study. Pre-and postoperative clinical examinations, age at epilepsy onset, age at operation, type of symptoms due to the CCM (seizures, headache, hemorrhage, focal deficits), type and frequency of epileptic seizures, and the localization and size of the CCM were assessed. Seizure outcome was determined in the first, second, and third postoperative years. Results:The CCM was completely resected in all patients. More than two thirds of the patients were classified as seizure free in the first 3 postoperative years. Predictors for good seizure outcome were age older than 30 years at the time of surgery, mesiotemporal CCM localization, CCM size <1.5 cm, and the absence of secondarily generalized seizures. No mortality occurred in our series, but only mild postoperative neurologic deficits in 12 (7%) patients.Conclusions: Considering the natural history of CCMs, the favorable neurologic and seizure outcome, surgical resection of CCMs should be considered in all patients with supratentorial CCMs and concomitant epilepsy, irrespective of the presence or absence of predictors for a favorable seizure outcome.

Resective surgery for medically refractory epilepsy using intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients

“…However, in lesional epilepsy and especially after CM resection in patients with epilepsy, outcomes are generally reported to be favorable, with rates of Engel Class I outcomes of 65%-86% in the literature. 4,9,15,21,29,64,80,84,87,88 Nevertheless, the CM seizure outcome results in the current study are among the top results reported in the literature. The rationale of these optimal results could be that we also performed resection of the hemosiderotic rim in nearly all patients with CM within the underlying study, as reported earlier.…”

Inherited cavernous malformations of the central nervous system: clinical and genetic features in 19 Swiss families

“…Surgery has particularly proven to be an effective treatment in CCMs manifesting with epilepsy. Patients become seizure-free in about 70% to 80% [1,3]. In our patients, 11 of 14 (78%) became seizure-free.…”

“…There is a large variety of studies reporting excellent surgical outcome following removal of CCMs [1,3,7,21]. Thus, in a large series of 72 patients, there was no mortality, and the immediate perioperative morbidity rate was 29.2% (21/72), while the rate of long-term morbidity was 5.5% (4/72).…”

Brainstem cavernous malformations: a review with two case reports

“…Baumann et al 31 recently published a large non-randomized study on seizure outcome after resection of single supratentorial CMs. Predictors for favorable seizure outcome after removal of CM include age >30 years, lesion size <1.5 cm, no additional seizure focus on eeG, and presence of simple partial or complex seizures.…”