Cerebral cavernomas and seizures: a retrospective study on 163 patients who underwent pure lesionectomy

Ferroli, Paolo; Casazza, Marina; Marras, Carlo Efisio; Mendola, C.; Franzini, Angelo; Broggi, Giovanni

doi:10.1007/s10072-006-0521-2

Cited by 116 publications

(101 citation statements)

References 24 publications

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“…The early surgical removal of superficial or not critically located CMs causing seizures may offer real curative treatment of epilepsy, preventing psychosocial disability in patients on long-term medical therapy and avoiding the risk of neurological deficits from growth and hemorrhage of the cavernomas [169, 170]. Surgery may also improve the efficiency of anticonvulsant therapy in patients with epilepsy who are resistant to medication [171,172,173]. Removal of the malformation through a simple lesionectomy may obtain good results for seizure outcome when there is concordance between the site of the epileptogenic cavernoma, the clinical semeiology and the interictal EEG [13,172,173,174,175,176].…”

Section: Resultsmentioning

confidence: 99%

Cavernous Malformations of the Central Nervous System in the Pediatric Age Group

et al. 2009

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Objective: The main clinico-diagnostic features, risk factors and associated diseases of cavernous malformations (CMs), also called cavernous angiomas or cavernomas, of the central nervous system (CNS) in children are described, and the most relevant differences compared to the affected adult population are pointed out, focusing on the management of pediatric patients harboring cranial and spinal CMs. Materials: This was a retrospective study of a series of 42 children symptomatic for CMs of the cranial and spinal compartments (35 supratentorial brain lesions, 5 infratentorial and 2 in the spinal region) operated on between 1975 and 2005, with a clinical follow-up ranging from 12 to 192 months. The results were compared with those found in the most recent literature dealing with pediatric CMs of the CNS. Results: Surgical treatment produced excellent or good results in 69% of our 42 children. Unchanged neurological deficits were observed in 23.8% of cases, while morbidity from surgical procedures was 7.14%. Mortality was absent in this series. These surgical results are comparable with those found in the literature, where morbidity and mortality rates from surgery are 8.8 and 1.13%, respectively, and are mostly associated with procedures for the excision of deep, critically located cavernomas. Conclusion: CMs represent the most common CNS vascular lesion in children, although their incidence is 4 times lower than that of the adult population. The natural history of pediatric CMs throughout the neuraxis seems to be more aggressive than in adult patients; these lesions have higher rates of growth and hemorrhage, larger dimensions and often atypical radiological pictures at diagnosis. Beside the familial form of the disease, which is more often associated with multiple lesions and an earlier age of clinical presentation, the major risk factor for CMs in children seems to be radiotherapy for CNS tumors. Furthermore, a greater number of CMs coexistent with mixed angiomatous lesions have been reported in children than in adults. Surgical results are related to the preoperative neurological status of the children; symptomatic patients who are operated on early, before they develop severe neurological deficits or long-standing seizures, may achieve the best clinical outcome. Radiosurgery does not seem to be advisable in children as an alternative treatment for deep CMs or those causing epilepsy.

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Section: Resultsmentioning

confidence: 99%

Cavernous Malformations of the Central Nervous System in the Pediatric Age Group

et al. 2009

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“…Ferroli et al [3] reported that 68/99 patients that presented with epilepsy were completely seizure free after pure lesionectomy alone. On the contrary, Hammen et al [4] reported that complete resection of hemosiderin fringe surrounding the cavernoma was correlated to less post-operative seizure frequency.…”

Section: Dear Editormentioning

confidence: 99%

Treatment strategies and outcome of pediatric cerebral cavernomas

Alexiou

Prodromou

2010

Neurol Sci

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We read with great interest the recent article by Consales et al. concerning the treatment and outcome of children with cerebral cavernomas. The authors prospectively studied 32 children with brain cavernomas. A great proportion of cavernomas (65.6%) had macrohemorrhage, whereas 15.6% presented only with seizures. Surgical excision was performed in 28 patients and resulted in favorable long-term outcome and seizure control. The authors concluded that there is a high risk of macrohemorrhage in children with cavernomas and surgery should be performed in most surgically accessible cavernomas [1].We retrospectively studied only the cerebral cavernomas that were treated surgically in our institute over the last 14 years. We identified 16 cases of pediatric cavernomas. The parietal lobe was the most common site of occurrence, whereas only two cavernomas were infratentorial. In our series, there were only 3 children with macrohemorrhage, whereas 14 children presented with seizures. Among them, 8 children had seizures that were controlled by medication, 2 cases were refractory to anticonvulsants and the remaining 4 patients were operated shortly after the first few seizures. In all cases, gross total resection was performed that included the surrounding gliotic and hemosiderin-stained brain parenchyma. After a mean follow-up period of 5.9 years, all patients were in good condition. Concerning the seizure outcome, as assessed by the Engel classification, 11 (78%) patients were seizure-free (class I) and 3 (22%) patients were in class II [2].

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“…3,9,28,33 Fortunately, at follow-up the rate of severe permanent neurological deficits descends to 2.6%-8%. 3,4,9,10,12,15,28,32,33 Our strategy employing FN and iopMRI only led to two mild (7.7%) and one moderate (3.8%) permanent visual field deficit, while the rate of post-surgical general complications was 7.7% and severe neurological deficits did not occur at all.…”

Section: 32mentioning

confidence: 99%

“…In patients with chronic epilepsy, seizure-freedom rates after 2 years of followup drop to 62. rate of 68.7% after a mean follow-up of 48 months. 28 If the hemosiderin-stained tissue is also removed, these seizure free rates reach 53-78%. 9,11,12 However, a current meta-analysis by Englot and colleagues found no statistical difference between the rate of seizure freedom in lesionectomy alone (75%) and extended lesionectomy with additional excision of the hemosiderin rim (76%), without any data from studies including intraoperative imaging.…”

Section: Surgical Strategiesmentioning

confidence: 99%

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Surgical management of epilepsy due to cerebral cavernomas using neuronavigation and intraoperative MR imaging

Sommer¹,

Kasper²,

Coras³

et al. 2013

Neurological Research

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Objectives: Cure from seizures due to cavernomas might be surgically achieved dependent on both, the complete removal of the cavernoma as well as its surrounding hemosiderin rim. High field intraoperative MRI imaging (iopMRI) and neuronavigation might play a crucial role to achieve both goals. We retrospectively investigated the long-term results and impact of intraoperative 1.5T MRI (iopMRI) and neuronavigation on the completeness of surgical removal of a cavernous malformation (CM) and its perilesional hemosiderin rim as well as reduction of surgical morbidity. Methods: 26 patients (14 female, 12 male, mean age 39.1 years, range: 17-63 years) with CM related epilepsy were identified. Eighteen patients suffered from drug resistant epilepsy (69.2%). Mean duration of epilepsy was 11.9 years in subjects with drug resistant epilepsy (n 5 18) and 0.3 years in subjects presenting with first-time seizures (n 5 8). We performed 24 lesionectomies and two lesionectomies combined with extended temporal resections. Seven lesions were located extratemporally. Results: Complete CM removal was documented by postsurgical MRI in all patients. As direct consequence of iopMRI, refined surgery was necessary in 11.5% of patients to achieve complete cavernoma removal and in another 11.5% for complete resection of additional adjacent epileptogenic cortex. Removal of the hemosiderin rim was confirmed by iopMRI in 92% of patients. Two patients suffered from mild (7.7%) and one from moderate (3.8%) visual field deficits. Complete seizure control (Engel class 1A) was achieved in 80.8% of patients with a mean follow-up period of 47.7 months. Discussion: We report excellent long-term seizure control with minimal surgical morbidity after complete resection of CM using our multimodal approach.

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Cerebral cavernomas and seizures: a retrospective study on 163 patients who underwent pure lesionectomy

Cited by 116 publications

References 24 publications

Cavernous Malformations of the Central Nervous System in the Pediatric Age Group

Cavernous Malformations of the Central Nervous System in the Pediatric Age Group

Treatment strategies and outcome of pediatric cerebral cavernomas

Surgical management of epilepsy due to cerebral cavernomas using neuronavigation and intraoperative MR imaging

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