Seizure outcome after lesionectomy for cavernous malformations

Abstract

Cavernous malformations that are associated with seizures are often treated by surgical resection consisting of lesion removal, "lesionectomy," alone. Through retrospective analysis the authors have examined some factors that may predict failure to eradicate seizures by such a procedure. A group of 51 patients were examined who had been treated for supratentorial cavernous malformations with preoperative seizures and received postoperative follow up lasting at least 1 year. There was one mortality in the group. Of the remaining 50 patients, 15 (30%) had continued postoperative seizures despite therapeutic levels of antiepileptic medications. Variables that were significantly associated with continued seizures postoperatively included increasing duration of preoperative seizure history (p = 0.03), increasing number of preoperative seizures (p < 0.003), and female sex (p < 0.04). One hundred percent of patients with only one preoperative seizure or a seizure history lasting less than 2 months were seizure free following lesionectomy: approximately 75% to 80% of all patients with two to five seizures, or a seizure history lasting 2 to 12 months, were seizure free; and only 50% to 55% of those with more than five seizures or with preoperative seizure histories lasting more than 1 year were seizure free postoperatively. This investigation indicates that patients with shorter seizure histories and fewer preoperative seizures can be effectively treated by lesionectomy alone, whereas those with longer histories and more seizures are not effectively treated by this procedure and may require more extensive resections.

Multiple Subpial Transection for Control of Epileptic Seizures: Effectiveness and Safety

“…Whereas favorable results and percentages of seizure-free patients as high as 82% have been reported after lesionectomy alone (28,29), improved seizure control after exact delineation and resection of the epileptogenic zone has been emphasized by other investigators (30-33). These data indicate that in patients with solitary circumscribed intracerebral lesions, such as solitary cavernomas, gangliogliomas or gliomas, or localized trauma, the zone of seizure origin very probably is either contiguous with or in close proximity to the lesion (30,34).…”

Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases

“…Longer seizure history and increased number of preoperative seizures are consistent with more difficulty in treating epilepsy with simple lesionectomy surgery 28 . We believe these patients should have a complete epilepsy evaluation to a possible extended surgery guided by electrocorticography.…”

“…In a series of patients submitted to lesionectomy of supratentorial CMs, a strict relationship was found between the duration of seizure history before the surgical treatment and the cure of epilepsy with the surgery. Cohen et al 28 showed that all patients that presented one preoperative seizure or less than two months of history did not have any seizures after surgery; 75.0 to 80.0% of patients with two to five preoperative seizures or 2 to 12 months of history also had not any seizure after surgery. In addition, 50% of patients with more than five seizures or more than 12 months of history were postoperatively seizure free 28 .…”

“…Cohen et al 28 showed that all patients that presented one preoperative seizure or less than two months of history did not have any seizures after surgery; 75.0 to 80.0% of patients with two to five preoperative seizures or 2 to 12 months of history also had not any seizure after surgery. In addition, 50% of patients with more than five seizures or more than 12 months of history were postoperatively seizure free 28 . Although resection of the hemosiderin stained tissue that surrounds the lesion was not proved to be of better effectiveness 4,[8][9][10]29 , it was adopted by several studies when CMs are placed in noncritical areas 2,3,9 , including the present one.…”

“…Lesionectomy alone showed favorable results 28 . In a series of patients submitted to lesionectomy of supratentorial CMs, a strict relationship was found between the duration of seizure history before the surgical treatment and the cure of epilepsy with the surgery.…”