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

Overview

Journal J Korean Neurosurg Soc

Date 2022 May 5

PMID 35508959

Authors

Tomasz A Dziedzic

Kacper Koczyk

Arkadiusz Nowak

Edyta Maj

Andrzej Marchel

Affiliations

Soon will be listed here.

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.

Citing Articles

Assessing the Relationship between Surgical Timing and Postoperative Seizure Outcomes in Cavernoma-Related Epilepsy: A Single-Institution Retrospective Analysis of 63 Patients with a Review of the Literature.

Nico E, Adereti C, Hackett A, Bianconi A, Naik A, Eberle A Brain Sci. 2024; 14(5).

PMID: 38790473 PMC: 11120247. DOI: 10.3390/brainsci14050494.

References

Sanmillan J, Lopez-Ojeda P, Fernandez-Conejero I, Fernandez-Coello A, Plans G, Ali-Ciurana Y . Treatment of cavernous malformations in supratentorial eloquent areas: experience after 10 years of patient-tailored surgical protocol. Acta Neurochir (Wien). 2018; 160(10):1963-1974. DOI: 10.1007/s00701-018-3644-3. View

Dziedzic T, Kunert P, Matyja E, Ziora-Jakutowicz K, Sidoti A, Marchel A . Familial cerebral cavernous malformation. Folia Neuropathol. 2012; 50(2):152-8. View

Kivelev J, Niemela M, Blomstedt G, Roivainen R, Lehecka M, Hernesniemi J . Microsurgical treatment of temporal lobe cavernomas. Acta Neurochir (Wien). 2010; 153(2):261-70. DOI: 10.1007/s00701-010-0812-5. View

von der Brelie C, Malter M, Niehusmann P, Elger C, 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. 2013; 54(9):1699-706. DOI: 10.1111/epi.12327. View

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. 2007; 16(3):248-53. DOI: 10.1016/j.seizure.2007.01.001. View

Rosenow F, Alonso-Vanegas M, Baumgartner C, Blumcke I, Carreno M, Gizewski E . Cavernoma-related epilepsy: review and recommendations for management--report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2013; 54(12):2025-35. DOI: 10.1111/epi.12402. View

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. 2011; 18(7):877-80. DOI: 10.1016/j.jocn.2010.12.008. View

von der Brelie C, Schramm J . Cerebral cavernous malformations and intractable epilepsy: the limited usefulness of current literature. Acta Neurochir (Wien). 2010; 153(2):249-59. DOI: 10.1007/s00701-010-0915-z. View

Akers A, Salman R, Awad I, Dahlem K, Flemming K, Hart B . 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. 2017; 80(5):665-680. PMC: 5808153. DOI: 10.1093/neuros/nyx091. View

10.

Zanello M, Meyer B, Still M, Goodden J, Colle H, Schichor C . Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers. Seizure. 2019; 69:31-40. DOI: 10.1016/j.seizure.2019.03.022. View

11.

Raabe A, Schmitz A, Pernhorst K, Grote A, von der Brelie C, Urbach H . Cliniconeuropathologic correlations show astroglial albumin storage as a common factor in epileptogenic vascular lesions. Epilepsia. 2012; 53(3):539-48. PMC: 3669690. DOI: 10.1111/j.1528-1167.2012.03405.x. View

12.

Yang P, Pei J, Jia Y, Lin Q, Xiao H, Zhang T . Surgical Management and Long-Term Seizure Outcome After Surgery for Temporal Lobe Epilepsy Associated with Cerebral Cavernous Malformations. World Neurosurg. 2017; 110:e659-e670. DOI: 10.1016/j.wneu.2017.11.067. View

13.

Robinson J, Awad I, Little J . Natural history of the cavernous angioma. J Neurosurg. 1991; 75(5):709-14. DOI: 10.3171/jns.1991.75.5.0709. View

14.

Baumann C, Acciarri N, Bertalanffy H, Devinsky O, Elger C, Lo Russo G . Seizure outcome after resection of supratentorial cavernous malformations: a study of 168 patients. Epilepsia. 2007; 48(3):559-63. DOI: 10.1111/j.1528-1167.2006.00941.x. View

15.

Josephson C, Leach J, Duncan R, Roberts R, Counsell C, Al-Shahi Salman R . Seizure risk from cavernous or arteriovenous malformations: prospective population-based study. Neurology. 2011; 76(18):1548-54. PMC: 3100127. DOI: 10.1212/WNL.0b013e3182190f37. View

16.

Noto S, Fujii M, Akimura T, Imoto H, Nomura S, Kajiwara K . Management of patients with cavernous angiomas presenting epileptic seizures. Surg Neurol. 2005; 64(6):495-8, discussion 498-9. DOI: 10.1016/j.surneu.2005.03.045. View

17.

Englot D, Han S, Lawton M, Chang E . Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations. J Neurosurg. 2011; 115(6):1169-74. DOI: 10.3171/2011.7.JNS11536. View

18.

Dammann P, Wrede K, Jabbarli R, Neuschulte S, Menzler K, Zhu Y . Outcome after conservative management or surgical treatment for new-onset epilepsy in cerebral cavernous malformation. J Neurosurg. 2016; 126(4):1303-1311. DOI: 10.3171/2016.4.JNS1661. View

19.

Yeon J, Kim J, Choi S, Seo D, Bong Hong S, Hong S . Supratentorial cavernous angiomas presenting with seizures: surgical outcomes in 60 consecutive patients. Seizure. 2008; 18(1):14-20. DOI: 10.1016/j.seizure.2008.05.010. View

20.

Van Gompel J, Rubio J, Cascino G, Worrell G, Meyer F . Electrocorticography-guided resection of temporal cavernoma: is electrocorticography warranted and does it alter the surgical approach?. J Neurosurg. 2009; 110(6):1179-85. PMC: 2841509. DOI: 10.3171/2008.10.JNS08722. View