Browse > Article
http://dx.doi.org/10.3340/jkns.2020.0224

Long-Term Management of Seizures after Surgical Treatment of Supratentorial Cavernous Malformations : A Retrospective Single Centre Study  

Dziedzic, Tomasz A. (Department of Neurosurgery, Medical University of Warsaw)
Koczyk, Kacper (Department of Neurosurgery, Medical University of Warsaw)
Nowak, Arkadiusz (Department of Neurosurgery, Medical University of Warsaw)
Maj, Edyta (Department of Clinical Radiology, Medical University of Warsaw)
Marchel, Andrzej (Department of Neurosurgery, Medical University of Warsaw)
Publication Information
Journal of Korean Neurosurgical Society / v.65, no.3, 2022 , pp. 415-421 More about this Journal
Abstract
Objective : Seizure recurrence after the first-ever seizure in patients with a supratentorial cerebral cavernous malformation (CCM) is almost certain, so the diagnosis and treatment of epilepsy is justified. The optimal method of management of these patients is still a matter of debate. The aim of our study was to identify factors associated with postoperative seizure control and assess the surgical morbidity rate. Methods : We retrospectively analysed 45 consecutive patients with a supratentorial CCM and symptomatic epilepsy in a single centre. Pre- and postoperative epidemiological data, seizure-related patient histories, neuroimaging results, surgery details and outcomes were obtained from hospital medical records. Seizure outcomes were assessed at least 12 months after surgery. Results : Thirty-five patients (77.8%) were seizure free at the long-term follow-up (Engel class I); six (13,3%) had rare, nocturnal seizures (Engel class II); and four (8.9%) showed meaningful improvement (Engel class III). In 15 patients (33%) in the Engel I group; it was possible to discontinue antiepileptic medication. Although there was not statistical significance, our results suggest that patients can benefit from early surgery. No deaths occurred in our study, and mild postoperative neurologic deficits were observed in two patients (4%) at the long-term follow-up. Conclusion : Surgical resection of CCMs should be considered in all patients with a supratentorial malformation and epilepsy due to the favourable surgical results in terms of the epileptic seizure control rate and low postoperative morbidity risk, despite the use of different predictors for the seizure outcome.
Keywords
Hemangioma, cavernous, central nervous system; Drug reistant epilepsy; Epilepsy surgery; Epilepsy outcome;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Baumann CR, Acciarri N, Bertalanffy H, Devinsky O, Elger CE, Lo Russo G, et al. : Seizure outcome after resection of supratentorial cavernous malformations: a study of 168 patients. Epilepsia 48 : 559-563, 2007   DOI
2 von der Brelie C, Schramm J : Cerebral cavernous malformations and intractable epilepsy: the limited usefulness of current literature. Acta Neurochir (Wien) 153 : 249-259, 2011   DOI
3 Yang PF, Pei JS, Jia YZ, Lin Q, Xiao H, Zhang TT, et al. : Surgical management and long-term seizure outcome after surgery for temporal lobe epilepsy associated with cerebral cavernous malformations. World Neurosurg 110 : e659-e670, 2018   DOI
4 Yeon JY, Kim JS, Choi SJ, Seo DW, Hong SB, Hong SC : Supratentorial cavernous angiomas presenting with seizures: surgical outcomes in 60 consecutive patients. Seizure 18 : 14-20, 2009   DOI
5 Raabe A, Schmitz AK, Pernhorst K, Grote A, von der Brelie C, Urbach H, et al. : Cliniconeuropathologic correlations show astroglial albumin storage as a common factor in epileptogenic vascular lesions. Epilepsia 53 : 539-548, 2012   DOI
6 Cappabianca P, Alfieri A, Maiuri F, Mariniello G, Cirillo S, de Divitiis E : Supratentorial cavernous malformations and epilepsy: seizure outcome after lesionectomy on a series of 35 patients. Clin Neurol Neurosurg 99 : 179-183, 1997   DOI
7 Chang EF, Gabriel RA, Potts MB, Garcia PA, Barbaro NM, Lawton MT : Seizure characteristics and control after microsurgical resection of supratentorial cerebral cavernous malformations. Neurosurgery 65 : 31-37; discussion 37-38, 2009   DOI
8 Sanmillan JL, Lopez-Ojeda P, Fernandez-Conejero I, Fernandez-Coello A, Plans G, Ali-Ciurana Y, et al. : Treatment of cavernous malformations in supratentorial eloquent areas: experience after 10 years of patienttailored surgical protocol. Acta Neurochir (Wien) 160 : 1963-1974, 2018   DOI
9 Zanello M, Meyer B, Still M, Goodden JR, Colle H, Schichor C, et al. : Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers. Seizure 69 : 31-40, 2019   DOI
10 Akers A, Al-Shahi Salman R, Awad IA, Dahlem K, Flemming K, Hart B, et al. : Synopsis of guidelines for the clinical management of cerebral cavernous malformations: consensus recommendations based on systematic literature review by the Angioma Alliance Scientific Advisory Board clinical experts panel. Neurosurgery 80 : 665-680, 2017   DOI
11 Dziedzic T, Kunert P, Matyja E, Ziora-Jakutowicz K, Sidoti A, Marchel A : Familial cerebral cavernous malformation. Folia Neuropathol 50 : 152- 158, 2012
12 Siegel AM, Roberts DW, Harbaugh RE, Williamson PD : Pure lesionectomy versus tailored epilepsy surgery in treatment of cavernous malformations presenting with epilepsy. Neurosurg Rev 23 : 80-83, 2000   DOI
13 Hammen T, Romstock J, Dorfler A, Kerling F, Buchfelder M, Stefan H : Prediction of postoperative outcome with special respect to removal of hemosiderin fringe: a study in patients with cavernous haemangiomas associated with symptomatic epilepsy. Seizure 16 : 248-253, 2007   DOI
14 Moran NF, Fish DR, Kitchen N, Shorvon S, Kendall BE, Stevens JM : Supratentorial cavernous haemangiomas and epilepsy: a review of the literature and case series. J Neurol Neurosurg Psychiatry 66 : 561-568, 1999   DOI
15 Robinson JR, Awad IA, Little JR : Natural history of the cavernous angioma. J Neurosurg 75 : 709-714, 1991   DOI
16 Rosenow F, Alonso-Vanegas MA, Baumgartner C, Blumcke I, Carreno M, Gizewski ER, et al. : Cavernoma-related epilepsy: review and recommendations for management--report of the surgical task force of the ILAE commission on therapeutic strategies. Epilepsia 54 : 2025-2035, 2013   DOI
17 Kivelev J, Niemela M, Blomstedt G, Roivainen R, Lehecka M, Hernesniemi J : Microsurgical treatment of temporal lobe cavernomas. Acta Neurochir (Wien) 153 : 261-270, 2011   DOI
18 Casazza M, Broggi G, Franzini A, Avanzini G, Spreafico R, Bracchi M, et al. : Supratentorial cavernous angiomas and epileptic seizures: preoperative course and postoperative outcome. Neurosurgery 39 : 26-32; discussion 32-34, 1996   DOI
19 Cohen DS, Zubay GP, Goodman RR : Seizure outcome after lesionectomy for cavernous malformations. J Neurosurg 83 : 237-242, 1995   DOI
20 von der Brelie C, Malter MP, Niehusmann P, Elger CE, von Lehe M, Schramm J : Surgical management and long-term seizure outcome after epilepsy surgery for different types of epilepsy associated with cerebral cavernous malformations. Epilepsia 54 : 1699-1706, 2013   DOI
21 Sevy A, Gavaret M, Trebuchon A, Vaugier L, Wendling F, Carron R, et al. : Beyond the lesion: the epileptogenic networks around cavernous angiomas. Epilepsy Res 108 : 701-708, 2014   DOI
22 Stavrou I, Baumgartner C, Frischer JM, Trattnig S, Knosp E : Long-term seizure control after resection of supratentorial cavernomas: a retrospective single-center study in 53 patients. Neurosurgery 63 : 888-896; discussion 897, 2008   DOI
23 Van Gompel JJ, Rubio J, Cascino GD, Worrell GA, Meyer FB : Electrocorticography-guided resection of temporal cavernoma: is electrocorticography warranted and does it alter the surgical approach? J Neurosurg 110 : 1179-1185, 2009   DOI
24 Josephson CB, Leach JP, Duncan R, Roberts RC, Counsell CE, Al-Shahi Salman R, et al. : Seizure risk from cavernous or arteriovenous malformations: prospective population-based study. Neurology 76 : 1548- 1554, 2011   DOI
25 Dammann P, Wrede K, Jabbarli R, Neuschulte S, Menzler K, Zhu Y, et al. : Outcome after conservative management or surgical treatment for new-onset epilepsy in cerebral cavernous malformation. J Neurosurg 126 : 1303-1311, 2017   DOI
26 Englot DJ, Han SJ, Lawton MT, Chang EF : Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations. J Neurosurg 115 : 1169-1174, 2011   DOI
27 Ferroli P, Casazza M, Marras C, Mendola C, Franzini A, Broggi G : Cerebral cavernomas and seizures: a retrospective study on 163 patients who underwent pure lesionectomy. Neurol Sci 26 : 390-394, 2006   DOI
28 Kim W, Stramotas S, Choy W, Dye J, Nagasawa D, Yang I : Prognostic factors for post-operative seizure outcomes after cavernous malformation treatment. J Clin Neurosci 18 : 877-880, 2011   DOI
29 Kraemer DL, Awad IA : Vascular malformations and epilepsy: clinical considerations and basic mechanisms. Epilepsia 35 Suppl 6 : S30-S43, 1994   DOI
30 Menzler K, Chen X, Thiel P, Iwinska-Zelder J, Miller D, Reuss A, et al. : Epileptogenicity of cavernomas depends on (archi-) cortical localization. Neurosurgery 67 : 918-924, 2010   DOI
31 Noto S, Fujii M, Akimura T, Imoto H, Nomura S, Kajiwara K, et al. : Management of patients with cavernous angiomas presenting epileptic seizures. Surg Neurol 64 : 495-498, discussion 498-499, 2005   DOI