gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

Surgical treatment of epileptogenic cavernous angiomas – pure lesionectomy or tailored resection?

Chirurgisches Management epileptogener zerebraler Kavernome – alleinige Kavernom-Exstirpation oder erweiterte, elektrokortikographisch kontrollierte Resektion?

Meeting Abstract

  • corresponding author W. Kleist-Welch Guerra - Klinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald
  • U. Runge - Klinik für Neurologie, Epilepsiezentrum, Ernst-Moritz-Arndt-Universität Greifswald
  • M.R. Gaab - Klinik für Neurochirurgie, Hannover
  • H.W.S. Schroeder - Klinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.11.04

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc151.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Kleist-Welch Guerra et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: The best surgical approach to treat epileptogenic cavernomas is still under controversy. We report on our retrospective series of 31 patients presenting with single or rare seizures in contrast to a medically intractable epilepsy associated with one or more supratentorial cavernomas and the outcome according to surgical treatment.

Methods: Thirty-one patients, 17 female and 14 male, aged 12-70 years (mean 37,39 years) with seizures and supratentorial cavernomas (multiple lesions in 5 patients) had been treated in our department (1993-2004). Frequency, duration and clinical pattern of seizures, cavernoma location, and antiepileptic drug regimen were examined. MRI, interictal scalp EEG, and angiography were performed in all cases. Surgery included lesionectomy alone (n=19), tailored resection including the cavernoma (n=11) and in one case of multiple cavernomas only resection of the inferior and medial temporal gyrus without cavernoma resection. Group A (n=17, 55%) included patients with a low seizure frequency and short seizure history, and these were treated by lesionectomy alone. Group B (n=9, 29%) included patients with medically intractable epilepsy, a high frequency and a long history of seizures. These patients were operated by tailored resection after additional preoperative evaluation (including ictal EEG with video monitoring; SPECT; WADA testing; neuropsychological testing). Five patients (16%) could not be included in any of these groups. Patients were followed for at least 12 months (mean 4,2 years).

Results: According to the criteria defined by ENGEL, 94% of the patients treated with lesionectomy alone (group A) had a favorable outcome (class I-II). All patients with only one seizure before surgery remained seizure free. The group of patients with medically intractable seizures (group B) also presented a favorable outcome in 90%, including one patient with multiple cavernomas, but no corresponding epileptogenic focus with one of the lesions (group C).

Conclusions: Based on our results, it is apparent that lesionectomy alone is sufficient in cases with only a single seizure and a short seizure duration. Patients with medically intractable seizures associated with cerebral cavernomas should be treated by tailored resection.