Surgical Management and Long-Term Seizure Outcome After Surgery for Temporal Lobe Epilepsy Associated with Cerebral Cavernous Malformations

Yang, Peng-Fan; Pei, Jia-Sheng; Jia, Yueping; Qiao, Lin; Xiao, Hu; Zhang, Tingting; Zhong, Zhong-Hui

doi:10.1016/j.wneu.2017.11.067

Cited by 14 publications

(23 citation statements)

References 29 publications

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“…Yang's research shows that surgery for intractable epilepsy can effectively control seizures. In addition, the appropriate operation scheme can be selected according to the location of CCMs and the responsiveness of patients to antiepileptic drugs to maximize the control of epilepsy and minimize post-operative neurological sequelae (68). He et al also reported the effectiveness of neurosurgery for intractable epilepsy and pointed out that the shorter the duration of seizures before surgery, the better the control of seizures after surgery (67).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Cerebral Cavernous Malformations Presenting With Seizures: A Systematic Review and Meta-Analysis

et al. 2020

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Background: Cerebral cavernous malformations (CCMs) presenting with seizures can be treated with neurosurgery or radiosurgery, but the ideal treatment remains unclear. Currently, there is no adequate randomized controlled trial comparing surgical treatment and radiotherapy for epileptogenic CCMs. Therefore, we conducted a systematic review and meta-analysis of available data from published literature to compare the efficacy and safety of neurosurgery and radiosurgery for epileptogenic CCMs. Methods: We performed a comprehensive search of the Ovid MEDLINE, Web of Science, PubMed, China Biological Medicine and China National Knowledge Infrastructure databases for studies published between January 1994 and October 2019. The search terms were as follows: "epilepsy," "seizures," "brain cavernous hemangioma," "cerebral cavernous malformation," "cerebral cavernous hemangioma," "hemangioma, cavernous, central nervous system." Two researchers independently extracted the data and reviewed all the articles. We compared the advantages and disadvantages of the two treatments. Results: A total of 45 studies were included in our analysis. Overall, the seizure control rate was 79% (95% CI: 75-83%) for neurosurgery and 49% (95% CI: 38-59%) for radiosurgery. In the neurosurgery studies, 4.4% of patients experienced permanent morbidity, while no patients in the radiotherapy studies had permanent morbidity. In addition, the results of subgroup analysis showed that ethnicity, CCMs location and average lesion number are likely significant factors influencing the seizure outcome following treatment. Conclusions: The epilepsy control rate after neurosurgery was higher than that after radiosurgery, but neurosurgery also had a relatively higher rate of permanent morbidity.

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Section: Discussionmentioning

confidence: 99%

Treatment of Cerebral Cavernous Malformations Presenting With Seizures: A Systematic Review and Meta-Analysis

et al. 2020

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“…Several studies have described the surgical management of epileptogenic CCM in general, 10,12,19 but few studies have addressed the details of surgical management for CCMs according to their specific anatomical location. 11,21 Surgical decision-making is challenging in CCMs located within the temporal lobe. Particularly in patients with temporal lobe CCMs and DRE, seizure outcome often depends on the decision of whether or not to additionally resect mesiotemporal structures.…”

Section: Surgical Treatment Of Ccm-related Epilepsymentioning

confidence: 99%

“…This is consistent with the results of previous studies, underlining the importance of epilepsy surgery in cases with CCM and DRE. 11,19,21 Nevertheless, in patients with CCMs located within the temporal lobe, competing pathological findings might interfere with the standard surgical preference of pure lesionectomy. Several studies have highlighted the importance of additional resection of the hemosiderin rim to gain seizure control.…”

Section: Dre In Temporal Lobe Ccmmentioning

confidence: 99%

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

Schuss¹,

Marx²,

Borger³

et al. 2020

Neurosurgical Focus

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OBJECTIVECavernoma-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.METHODSFrom 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).RESULTSOverall, 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.CONCLUSIONSFavorable 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.

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“…Surgery for an epileptogenic cerebral cavernous malformation (cavernoma) in the temporal lobe, and the necessity of additional hippocampectomy remains in dispute [1]. When the cavernoma directly involves the hippocampus, the decision to undertake medial resection is relatively straightforward [2], [3]. However, when medial structures are not involved the potential risks and benefits of medical resection must be considered carefully, on a case-by-case basis [1].…”

Section: Introductionmentioning

confidence: 99%

“…This theory is referred to as “dual pathology” when coexistence of hippocampal sclerosis with an extrahippocampal cavernoma is present [1], [5]. To evaluate these phenomena, guidance using intraoperative electrocorticography (ECoG) recording has been recommended [1], [3], [6]. Although intraoperative ECoG does not require placement of depth electrodes, it is generally accepted that the area that generates paroxysmal epileptiform activity on ECoG recorded during the operation is not always identical to the epileptogenic zone [7], [8].…”

Section: Introductionmentioning

confidence: 99%

Continuous ictal discharges with high frequency oscillations confined to the non-sclerotic hippocampus in an epileptic patient with radiation-induced cavernoma in the lateral temporal lobe

Mukae

Morioka

Torio

et al. 2019

Epilepsy & Behavior Case Reports

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Intraoperative electrocorticography recording is recommended for treating cavernoma-related epilepsy. However, interictal paroxysmal epileptiform activity is generally able to be recorded, but is not always identical to the epileptogenic zone.We surgically treated a 15-year-old girl with drug-resistant epilepsy associated with radiation-induced cavernoma in the right lateral temporal lobe. Electrocorticography revealed paroxysmal activities in the cortex around the cavernoma. Additionally, continuous subclinical “ictal” discharges with high-frequency oscillations confined to the histologically non-sclerotic hippocampus were recorded. Following additional hippocampectomy, a good seizure outcome was obtained.Intraoperative electrocorticography and high-frequency oscillation analysis revealed high epileptogenicity in the non-sclerotic hippocampus of this patient.

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Surgical Management and Long-Term Seizure Outcome After Surgery for Temporal Lobe Epilepsy Associated with Cerebral Cavernous Malformations

Cited by 14 publications

References 29 publications

Treatment of Cerebral Cavernous Malformations Presenting With Seizures: A Systematic Review and Meta-Analysis

Treatment of Cerebral Cavernous Malformations Presenting With Seizures: A Systematic Review and Meta-Analysis

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

Continuous ictal discharges with high frequency oscillations confined to the non-sclerotic hippocampus in an epileptic patient with radiation-induced cavernoma in the lateral temporal lobe

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