Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers

Zanello, Marc; Meyer, Bernhard; Still, Megan; Goodden, John; Colle, Herbert A.; Schichor, Christian; Bello, Lorenzo; Wager, Michel; Smits, Anja; Rydenhag, Bertil; Tate, Matthew C.; Métellus, Philippe; Hamer, Philip de Witt; Spena, Giannantonio; Laurent, Césari; Mandonnet, Emmanuel; Robles, Santiago Gil; Sarubbo, Silvio; González, Juan Martino; Fontaine, Denys; Reyns, Nicolas; Krieg, Sandro M.; Huberfeld, Gilles; Wostrack, Maria; Colle, David; Espesser, Robert; Noens, B.; Müller, P; Yusupov, Natan; Rossi, Marco; Nibali, Marco Conti; Papagno, Costanza; Visser, V.S.; Baaijen, Hans; Galbarritu, Lara; Chioffi, Franco; Bucheli, Carlos; Roux, Alexandre; Dezamis, Edouard; Duffau, Hugues; Pallud, Johan

doi:10.1016/j.seizure.2019.03.022

Cited by 19 publications

(18 citation statements)

References 30 publications

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“…Our results from patients in the EG returned to work compared to a larger multicentric survey from Zanello et al showed a lower proportion of patients returning to work (59.3% vs 88.6%, respectively). [38] This difference between our results and this survey is hard to explain since both studies lack a suppurative socioeconomic data of these patients. The mean age of both populations (42.4 vs. 40.2 years) as well as the slight female predominance (53.7% vs 59.6%), and functional worsening at the follow-up (14.6% vs 12.9%) were similar.…”

Section: Return To Workcontrasting

confidence: 85%

Long-Term Outcome and Quality of Life After Cavernoma Resection: Eloquent vs. Non-Eloquent Areas.

Shoubash

Baldauf

Matthes

et al. 2021

Preprint

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Objective: To analyze the long-term quality of life after surgery of cavernoma.Methods: A monocentric retrospective study was conducted on 69 patients with cavernoma treated microsurgically between 2000 and 2016. The eloquence was adopted from Spetzler-Martin definition. A most recent follow-up was elicited between 2017 and 2019, in which the quality of life (QoL) was evaluated with the Short Form-12 questionnaire (SF12).Results: 41 lesions were in eloquent group (EG), 22 in non-eloquent group (NEG), 3 in orbit and 3 in the spinal cord. Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. After a mean follow-up of 6.5 years, the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. 44 patients (EG n =27, NEG n = 14) attended the last follow-up. The EG had mostly comparable QoL results matched to NEG except for the physical role (RP). The study population when compared to the norms, did well on only half of the parameters of SF12. Yet, the general health (GH), vitality, physical (RP) and emotional roles (RE) were significantly inferior.Conclusion: At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. Regarding QoL, Patients after eloquent cavernoma resection reported a non-inferior QoL in most SF12 domains (except for physical role) compared to NEG. However, they reported general health perception inferior to norms, which was affected by the limited physical and emotional roles.

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Section: Return To Workcontrasting

confidence: 85%

Long-Term Outcome and Quality of Life After Cavernoma Resection: Eloquent vs. Non-Eloquent Areas.

Shoubash

Baldauf

Matthes

et al. 2021

Preprint

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“…It has been recently reported that only 58% of cases of SCA benefit from intraoperative direct electrostimulation, with only 66% of the cases undergoing awake craniotomy. 1 One of the main alleged drawbacks of the procedure is its complexity and the supposed procedure-related discomfort for the patient.…”

Section: Discussionmentioning

confidence: 99%

“…The above-mentioned surgical risk implies that surgical attempt to remove SCA located within or near a suspected eloquent area is not as frequent as expected, 19 and conservative management is frequently favoured to avoid surgical complications. 1 However, since no therapeutic alternative or associated treatment has proved to be that effective, 22 complete resection of SCA remains the main goal in SCA treatment. 18 In this setting, establishing secure surgical corridors to reach subcortical, sometimes deep-seated SCA and finding safe functional boundaries of resection, seems of paramount importance to attempt complete resection.…”

Section: Discussionmentioning

confidence: 99%

“…Cavernomas (CA) account for 5-15% of intracranial vascular malformations, [1][2][3] being seizures (25% of patients) and neurological symptoms related to a haemorrhagic event (25% of patients) the most common clinical presentation. Complete resection of supratentorial cavernoma (SCA) and removal of the surrounding gliotic area (or hemosiderin rim) is recommended to minimize the risk of postoperative persistent seizures or (re)bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…Hence, meticulous planification of surgery, including cortico-subcortical intraoperative brain stimulation (ioBS) in the awake patient, also known as awake brain mapping, has been advised so that the less hazardous approach to cavernoma could be chosen. 1,4,5 Intraoperative language mapping under local anaesthesia has been probed to minimize the risk of postoperative language deficit 6,7 in brain tumour patients. Nevertheless, not only language-related functions but other higher functions, including visuospatial cognition, sociocognitive functions and executive functions can be tested intraoperatively by means of ioBS 8,9 thus contributing to improve postoperative clinical outcome and quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative brain mapping during awake surgery in symptomatic supratentorial cavernomas

et al. 2021

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Background: Complete resection of symptomatic supratentorial cavernoma (SCA) and removal of the surrounding gliotic area is recommended to minimize the risk of persistent seizures or (re)bleeding. Surgery of SCA located in an eloquent area, can carry out severe postoperative neurological morbidity. We report a study aimed to assess feasibility, extent of resection and outcome after surgical removal of CA by cortico-subcortical intraoperative brain stimulation (ioBS) in the awake patient.Methods: Six patients diagnosed of symptomatic SCA located on an eloquent area and operated on while awake under local anaesthesia ioBS, were included. Preoperative planning included neuropsychologic assessment of language-related functions, sociocognitive functions and executive functions. Intraoperatively, we recorded the results achieved in the planned neuropsychological tasks when stimulation was applied (cortical and subcortical).Postoperative control 3D MRI was scheduled at 1 month after surgery to calculate extent of resection. Neuropsychological assessment at 6 months after surgery was performed in all cases.Results: Six patients (5 females, 1 male) aged 24-48 years were included in our study. Locations of the lesions were right insular (n = 1), left insular (n = 1), left temporo-insular (n = 1), left temporal (n = 2) and left frontal (n = 1). In all patients, positive findings were obtained during ioBS. In 5 patients, complete surgical resection was achieved. Two patients had postoperative transient neurological deficits, one case of hemiparesis, one case of dysnomia, both cleared over a 6-month period. Clinical follow-up revealed that all patients experienced complete recovery from preoperative symptoms within a year and five patients with seizures showed marked improvement and eventually quit antiepileptic drugs. Neuropsychological assessment at 6 months provided normal results compared to preoperative baseline in all domains.

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

et al. 2022

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Background:To estimate the quality of life, anxiety, depression, and illness perception in patients with medically treated cerebral cavernous malformation (CCM) and associated epilepsy. Methods: Nonsurgically treated patients with CCM-related epilepsy (CRE) were included. Demographic, radiographic, and clinical features were assessed. All participants received established questionnaires (short-form 36 health survey, SF-36; hospital anxiety and depression score, HADS-A/D; visual analogue scale score, VAS) assessing the functional and psychosocial burden of disease. To some extent, calculated values were compared with reference values from population-based studies. Test results were related to seizure control. Results: A total of 37 patients were included. Mean age was 45.8 ± 14.4 years, and K E Y W O R D S anxiety, cerebral cavernous malformation, depression, epilepsy, quality of life This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers

Cited by 19 publications

References 30 publications

Long-Term Outcome and Quality of Life After Cavernoma Resection: Eloquent vs. Non-Eloquent Areas.

Long-Term Outcome and Quality of Life After Cavernoma Resection: Eloquent vs. Non-Eloquent Areas.

Intraoperative brain mapping during awake surgery in symptomatic supratentorial cavernomas

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

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