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

Abstract

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.

Magnetic resonance‐guided laser interstitial thermal therapy fordrug‐resistantepilepsy: A systematic review and individual participant datameta‐analysis

“…[70][71][72] In a meta-analysis by Gao et al, 13.1% and 4.4% of patients with CCM experienced temporary and permanent neurological deficits after lesionectomy, respectively. 68 By comparison, only 9% of our CCM cohort experienced transient deficits and no patients experienced permanent deficits. One of the main concerns regarding MRgLITT of CCM is hemorrhage; however, only 1 of 32 patients (3.1%) in our study experienced postoperative hemorrhage, again reinforcing that MRgLITT may be a safe alternative to open resection with similar efficacy.…”

“…Open microsurgical lesionectomy is considered the gold standard for treating DRE attributed to CCMs; however, the 78.1% seizure freedom rate with MRgLITT in this study compares favorably to open resection (70%-80%). [66][67][68] Given similar efficacy to open surgery, MRgLITT offers additional advantages of being minimally invasive and reducing microsurgical approach-related morbidity for deep-seated CCMs. MRgLITT may also be appealing for patients with multiple CCMs.…”

Radiosurgery effects and adverse effects in symptomatic eloquent brain-located Cavernomas

“…Gao et al. [ 33 ] found that the seizure control rate was 79% for neurosurgery and 49% for radiosurgery. However, our total seizure control rate was 78.2% in these patients, who we followed as a single center.…”

Hemorrhage of a Cavernous Hemangioma of the Brainstem Presenting with Fever of Unknown Origin: A Case Report

“…These vessels lack muscular and elastic layers and are filled with blood at various stages of thrombosis and organization [ 6 , 7 ]. Sluggish blood flow through dysplastic channels results in recurrent thrombosis, calcification, and deposition of hemosiderin along the margins of the lesion [ 8 ].…”