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57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Cavernous angiomas in epilepsy surgery – ten years of experience in the Bethel Epilepsy Center

Kavernome in der Epilepsiechirurgie – Erfahrungen aus zehn Jahren am Epilepsie-Zentrum Bethel

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  • corresponding author F.W. Behne - Bethel Epilepsy Center, Bielefeld
  • R. Lahl - Institut Of Neuropathology EVKB, Bielefeld
  • R. Villgran - Institut Of Neuropathology EVKB, Bielefeld
  • V. Hans - Institut Of Neuropathology EVKB, Bielefeld
  • F. Wörmann - Bethel Epilepsy Center, Bielefeld
  • T. H. May - Bethel Epilepsy Center, Bielefeld
  • F. Oppel - Clinic of Neurosurgery EVKB, Bielefeld
  • B. Pohlmann-Eden - Bethel Epilepsy Center, Bielefeld
  • I. Tuxhorn - Bethel Epilepsy Center, Bielefeld
  • A. Ebner - Bethel Epilepsy Center, Bielefeld
  • H.W. Pannek - Bethel Epilepsy Center, Bielefeld

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.11.05

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc152.shtml

Published: May 8, 2006

© 2006 Behne et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Epileptic seizures are the most frequent presenting clinical symptom in patients with supratentorial cavernous angiomas (CA). Major indications for surgical treatment are pharmaco-resistance and the risk of hemorrhage. The purpose of this retrospective, one centre study was to determine the clinical outcome after epilepsy surgery in patients suffering from epilepsy due to CAs.

Methods: Between February 1994 and November 2005 forty four patients with epilepsies caused by CAs were operated on at the Bethel epilepsy center. Standard diagnostic methods used were video-EEG-monitoring, high resolution MRI, neuropsychological assessments (e.g. Wada-testing) and functional MRI. Subdural grid electrodes and ECoG were applied if necessary. The operations were performed as “individually tailored resections”. A neuropathological examination was carried out regularly.

Results: Thirty-five (80%) of 44 patients between 9 and 71 years of age were followed up for a period between 2 months and 8 years (mean 16 months). Eight (18,2%) patients had multiple CAs. Genetical inquiries were not carried out. Mean duration of the epilepsy before the operation was 12 months. Seizure control according to the Engel classification class 1 (seizure-free) could be achieved in a total of 23 patients (65,7%) and according to Engel’s class 2 (almost seizure-free) in 4 (11,4%) patients. Eleven (25%) patients presented with a dual pathology such as hippocampus sclerosis and/or a cortical dysplasia (CD) as well. Postoperative seizure control (Engel class 1) was significantly (Chi-square, p=0,024) reduced from 76% to 40% if the CA was associated with a furtherl pathology. This result was independent of the localization and multiplicity of CAs.

Conclusions: After epilepsy surgery 76% of patients with symptomatic epilepsies caused by CAs were seizure-free according to Engel's class 1 if they had no further pathology. Dual pathology (CA plus CD and/or hippocampal sclerosis) significantly reduced (40%) seizure control with a less favourable postoperative outcome.