gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Long-term outcome after resection of cerebral cavernous malformation-associated epilepsy

Meeting Abstract

  • C. von der Brelie - Department of Neurosurgery, University of Bonn Medical Center
  • J. Schramm - Department of Neurosurgery, University of Bonn Medical Center
  • M. von Lehe - Department of Neurosurgery, University of Bonn Medical Center

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.13.06

doi: 10.3205/11dgnc102, urn:nbn:de:0183-11dgnc1023

Published: April 28, 2011

© 2011 von der Brelie et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The current data on the surgical therapy of cerebral cavernous malformation (CCM)-associated epilepsy is not sufficient since most studies do not carefully differentiate therapy and outcomes for different epilepsy types. Providing data on long-term outcome is essential since it has been shown that favorable seizure outcome may not be entirely stable.

Methods: Patient history, preoperative workup, surgical reports and – if available – cranial MRI were analyzed for type of seizure disorder, functional and seizure outcome.

Results: Between 1990 to 2008, 108 patients underwent surgery for CCM-associated epilepsy (25 single seizures, 26 chronic, but not drug-resistant epilepsy, 57 drug-resistant epilepsy). 38 CCM were located temporomesially, 66 temporolaterally or other neocortical regions, 4 exclusively subcortically). 70 patients had detailed preoperative workup including 20 patients with invasive monitoring. The hemosiderotic rim was completely resected in 37 patients. In 65 cases, extended lesionectomy (incl. rim and perilesional tissue or extended resections) was performed according to preoperative electrophysiological data and/or intraoperative ECOG. Due to proximity to eloquent brain regions, only an incomplete removal of the hemosiderotic rim was possible in 6 patients. Intraoperative neuromonitoring was used in 10 patients (7 MEP/SEP, 2 awake craniotomies, 1 ECOG); neuronavigation was used in 36 cases.14 patients developed a permanent postoperative deficit including 12 patients with partial visual field defects as a calculated deficit. Long-term follow-up (>36 months) was available in 94 patients (including 49 with drug-resistant epilepsy). 81.6% of patients with drug-resistant epilepsy were completely seizure-free (mean follow-up 101 months) whereas 8.9% of patients with previously sporadic seizures or non-resistant seizures suffered from drug-resistant epilepsy post-operatively (mean follow-up 132 months).

Conclusions: Surgery on CCM-associated epilepsy is safe. In case of drug-resistant epilepsy, the rate of complete seizure relief is excellent after detailed preoperative workup. On the other hand, patients with sporadic or chronic epilepsy may develop refractory epilepsy.