gms | German Medical Science

Objective: The aim of this study was to evaluate the preoperative course and long-term results of microsurgically resected supratentorial cavernomas associated with epilepsy.

Methods: Between 1981 and 2004 63 (28 female, 35 male) patients harbouring radiologically diagnosed supratentorial cavernous malformations presenting with epileptic seizures underwent surgery at our institute. Patient data such as duration of illness, frequency and type of seizures, lesion location, multiplicity and size were recorded in retrospect. The seizures were divided into simple partial, complex partial and generalised seizures. Long-term follow-up was conducted in 53 patients (22 female, 31 male). The Engel classification was used to evaluate the postoperative outcome. The mean follow-up was 8 years (0.6 – 18.6 y).

Results: The mean duration of illness was 3.4 years (0.1 – 24 y). 24 patients (45.3%) had experienced only a single seizure or had a sudden onset of seizures shortly before the operation. 29 patients (54.7%) had a history of chronic epilepsy. The frequency ranged from several seizures a year (28.3%) over several a month (26.4%) to daily seizures (11.3%). In 34% of patients only 1 seizure led to the radiological diagnosis of a cavernous malformation. Seizure types were divided into 69.8% generalised seizures, 11.3% simple partial seizures and 18.9% complex partial seizures. The location of the lesion was temporal in 41.5%, frontal in 30.2%, parietal in 17.0%, occiptal in 5.7% and multiple in 5.7%. The mean lesion size was 1.9cm (1–4cm). 18 patients (34.0%) presented with a clinically significant and radiologically diagnosed acute hemorrhage shortly before surgery. Because there were patients with multiple lesions, 57 surgeries were performed on the 53 patients. The histological examination revealed 61.4% cavernomas, 17.5% mixed lesions, 12.3% AVMs and 8.8% atypical vascular malformations. At the time of follow-up 69.8% of patients were completely free of postoperative seizures (Engel class I A). Generally 84.9% of patients were Engel class I and 5.7% Engel class II. At follow-up only 4 patients (7.5%) had persisting new neurological deficits.

Conclusions: Microsurgical resection of cavernous malformation associated with epilepsy results in a favourable outcome.