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 in cerebral cavernous malformation-associated epilepsy in pediatric patients

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.13.07

DOI: 10.3205/11dgnc103, URN: urn:nbn:de:0183-11dgnc1035

Published: April 28, 2011

© 2011 von der Brelie et al.
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Outline

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Objective: Cerebral cavernous malformations (CCM) in children often become symptomatic with epileptic seizures. The current data on the surgical therapy of CCM-associated epilepsy is not sufficient concerning outcome for different epilepsy types, especially for functional and seizure outcome. Providing data on long-term outcome is essential since it has been shown that favorable seizure outcome may not be entirely stable.

Methods: Hospital records, surgical reports and -if available- cranial MRI were analyzed for type of seizure disorder, preoperative work-up, extent of resection and long-term follow-up.

Results: Overall, 31 children received surgical treatment for a CCM between 1990 and 2008. 18 patients presented with symptomatic epilepsy (5 single/sporadic seizures, 7 chronic, but not drug-resistant epilepsy, 6 drug-resistant epilepsy). Mean age was 14.27 years (range 3–18 years). Mean duration of seizures was 2.69 years. All CCM harbored a surrounding hemosiderotic rim. 15 CCM were located temporolaterally or in other neocortical regions (3 temporomesial). 5 patients had multiple CCM in whom the symptomatic CCM was removed. In 11 patients, detailed preoperative workup was performed and 3 patients underwent invasive EEG recording. In 11 cases extended lesionectomy (incl. rim /perilesional tissue/ bigger 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 3 cases. Intraoperative neuromonitoring was used in 4 patients (2 MEP/SEP, 1 ECOG). Neuronavigation was used in 4 cases. One patient developed a visual field defect (quadrantanopia) as a calculated deficit. Mean follow-up of patients with single/sporadic seizures and chronic epilepsy was 11.7 years; regarding the long-term, all patients were seizure-free. Patients with drug-resistant epilepsy had a mean follow-up of 9.7 years and favorable long-term outcome (ILAE 1–3) was achieved in 83%.

Conclusions: Surgery on CCM-associated epilepsy in children is effective and safe. Children with drug-resistant epilepsy and even multiple CCM should be considered for surgery after a detailed epileptological workup. In terms of follow-up, long-term seizure outcome is stable.