Artikel
Cavernoma-related epilepsy in cavernous malformations located within the temporal lobe – surgical management and seizure outcome
Epilepsie bei temporal gelegenen Kavernomen – Management und Anfallsoutcome
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Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Cavernoma-related epilepsy (CRE) is a frequent symptom in patients with cerebral cavernous malformation (CCM). Reports on surgical management and seizure outcome of epileptogenic CCM often focus on CCMin general. Therefore, data on CCM within the temporal lobe is scarce. We therefore analyzed our institutional data.
Methods: From 2002 to 2018, 52 patients suffering from CCM located within the temporal lobe underwent surgery for CCM-associated epilepsy in our institution. Information on patient characteristics, preoperative seizure history, preoperative evaluation, surgical strategies, postoperative complications, and seizure outcome were assessed and further analyzed. Seizure outcome was assessed 12 months after surgery according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class I) versus unfavorable (ILAE classes II–VI).
Results: Overall, 47 of 52 patients (90%) with CCM located temporal and CRE achieved favorable seizure outcome. Pure lesionectomy was performed in 5 patients, extended lesionectomy with resection of hemosiderin rim in 38 patients, and anterior temporal lobectomy in 9 patients with temporal CCM. In detail, 36 patients (69%) suffered from drug-resistant epilepsy (DRE), 3 patients from chronic CRE (6%), and 13 patients sustained sporadic CRE (25%). In patients with DRE favorable seizure outcome was achieved in 32 of 36 patients (89%). Patients with DRE were significantly older than patients with CCM-associated chronic or sporadic seizures (p=0.02). Furthermore, patients with DRE underwent more often additional amygdalohippocampectomy following the recommendation of pre-surgical epileptological evaluation.
Conclusion: Favorable seizure outcome is achievable in a substantial number of patients with epileptogenic CCM located temporal, even if patients suffered from drug-resistant CRE. For adequate counseling and monitoring, patients with CRE should undergo thorough pre- and post-surgical evaluation in dedicated epilepsy surgery programs.