Seizure outcome after surgical resection of supratentorial cavernous malformations plus hemosiderin rim in patients with short duration of epilepsy

Jin, Yichao; Zhao, Changyi; Zhang, Shilei; Zhang, Xiaohua; Qiu, Yongming; Jiang, Jiyao

doi:10.1016/j.clineuro.2014.01.013

Cited by 16 publications

(10 citation statements)

References 25 publications

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“…Our study as well as many reported series [20][21][22][23] has shown that there is no significant association between temporal location of the lesion and seizure outcome; on the other hand, several studies demonstrated that CM location is worthy of concern. This inconclusiveness may be partially because of mesial temporal lesions.…”

Section: Discussioncontrasting

confidence: 44%

Surgical Treatment and Long-Term Outcome of Cerebral Cavernous Malformations-Related Epilepsy in Pediatric Patients

et al. 2018

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Cerebral cavernous malformations (CMs) are vascular malformations affecting any part of the central nervous system. Clinical data and surgical outcomes for 27 pediatric patients with CM-related epilepsy were retrospectively reviewed. The mean age of onset was 12.71 ± 4.09 years, and the mean duration of epilepsy was 2.34 ± 1.95 years. All 27 patients were treated with microsurgery for resection of the CMs, and the hemosiderin rim, and the secondary epileptogenic zone if necessary. The mean follow-up period was 6.34 ± 3.35 years, and the overall postoperative outcomes were positive. Note that 77.8% of patients were seizure-free postoperatively. The other patients with residual epilepsy received incomplete resection of the hemosiderin rim or the secondary epileptogenic zone due to retention of vital neurological functions. Surgical treatment for pediatric patients with symptomatic supratentorial CMs is safe and effective. Early intervention is recommended to resect CMs, the hemosiderin rim, and the epileptogenic cortex, even in cases of multiple CMs.

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Section: Discussioncontrasting

confidence: 44%

Surgical Treatment and Long-Term Outcome of Cerebral Cavernous Malformations-Related Epilepsy in Pediatric Patients

et al. 2018

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“…Surgical removal of the CCM and the hemosiderin rim was regarded as the treatment of choice for patients with intractable seizures. [ 4 ] One hypothesis that had gained broad acceptance was that the hemosiderin surrounding CCM induced pathologic changes of adjacent brain tissues, increased excitatory amino acid levels, and triggered the abnormal excitability of adjacent neurons. [ 18 ] However, the value of completely resecting the hemosiderin rim remained inconsistent in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 ] Blood breakdown products affecting adjacent brain tissue is considered the main cause of seizures. [ 4 ] Approximately 35% to 40% of all patients with CCM-related seizures may experience chronic or even drug-resistant seizures. [ 5 ] For these cases, surgical removal of the lesion is regarded to be the most effective management of intractable seizures.…”

Section: Introductionmentioning

confidence: 99%

A predicted model for postoperative seizure outcomes after the surgical resection of supratentorial cavernous malformations

Wang

Shrestha

et al. 2016

Medicine

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To explore a predicted model for postoperative seizure outcomes after the surgical resection of supratentorial cavernous malformations.This study was a retrospective review of consecutive patients with cerebral supratentorial cavernous malformations presenting with seizures. All patients underwent surgical resection of CCMs. Univariate and multivariate analyses were performed to determine the predictive value of the preoperative seizure frequency, seizure type, seizure duration, lesion location, lesion size, and the presence of residual hemosiderin.A total of 43 patients met the inclusion criteria. After a mean follow-up period of 40.95 months, 34 patients who were free from postoperative seizures were classified into Engel class I, and the remaining 9 patients were classified into Engel classes II–IV. A univariate analysis showed that the seizure frequency (χ2 = 13.440, P = 0.004) and seizure duration (χ2 = 5.145, P = 0.023) prior to surgery were associated with a worse postoperative seizure prognosis. Other covariates including age at onset, gender, a history of the medications taken, smoking status, family history, lesion characteristics, and the role of hemosiderin were not related to seizure outcomes. Logistic regression results demonstrated that the preoperative seizure frequency was an effective predictor (P = 0.004). The receiver operating characteristic curve indicated that area under the curve for the preoperative seizure frequency test was 0.833 (95% confidence interval 0.709–0.957, P = 0.002).The preoperative seizure frequency was a prognostic factor for postoperative seizure outcomes after surgical resection of supratentorial cavernous malformations. To obtain a favorable prognosis for CCM patients with preoperative seizures, early intervention might be a better choice.

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“…It was generally known that the surgical description of hemosiderin removal might differ from postoperative MRI controls, so we’d better use post-operative MRI, which could reflect hemosiderin ring excision more objectively, as the assessment criteria. Second, hemosiderin excision was only one of the factors related to seizure outcome in most studies, and only three articles [ 15 , 17 , 29 ] directly compare a hemosiderin excision group and a control group. Therefore, the patient baseline characteristics for the hemosiderin (+) group and hemosiderin (-) group were usually unavailable or incomplete, leading to the loss of some evidence in the subgroup analysis.…”

Section: Discussionmentioning

confidence: 99%

The Role of Hemosiderin Excision in Seizure Outcome in Cerebral Cavernous Malformation Surgery: A Systematic Review and Meta-Analysis

Ruan

Shrestha

et al. 2015

PLoS ONE

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Background and PurposeWhether the excision of hemosiderin surrounding cerebral cavernous malformations (CCMs) is necessary to achieve a seizure-free result has been the subject of debate. Here, we report a systematic review of related literature up to Jan 1, 2015 including 594 patients to assess the effect of hemosiderin excision on seizure outcome in patients with CCMs by meta-analysis.MethodsTen studies comparing extended hemosiderin excision with only lesion resection were identified by searching the English-language literature. Meta-analyses, subgroup analyses and sensitivity analysis were conducted to determine the association between hemosiderin excision and seizure outcome after surgery.ResultsSeizure outcome was significantly improved in the patients who underwent an extended excision of the surrounding hemosiderin (OR, 0.62; 95% CI: 0.42–0.91; P = 0.01). In subgroup analysis, studies from Asia (OR, 0.42; 95% CI: 0.25–0.71; P = 0.001), male-majority (female ratio < 50%) studies (OR, 0.56; 95% CI: 0.33–0.96; P = 0.04), low occurrence rate of multiple CCMs (OR, 0.37; 95% CI: 0.20–0.71; P = 0.003), cohort studies (OR, 0.44; 95% CI: 0.28–0.68; P = 0.78), longer duration of seizure symptoms (> 1 year) before surgery (OR, 0.43; 95% CI: 0.22–0.84; P = 0.01), lesion diameter > 2 cm (OR, 0.41; 95% CI: 0.19–0.87; P = 0.02) and short-term (< 3 years) follow-up (OR, 0.48; 95% CI: 0.29–0.80; P = 0.005) tended to correlate with a significantly favorable outcome.ConclusionPatients who underwent extended surrounding hemosiderin excision could exhibit significantly improved seizure outcomes compared to patients without hemosiderin excision. However, further well-designed prospective multiple-center RCT studies are still needed.

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Seizure outcome after surgical resection of supratentorial cavernous malformations plus hemosiderin rim in patients with short duration of epilepsy

Cited by 16 publications

References 25 publications

Surgical Treatment and Long-Term Outcome of Cerebral Cavernous Malformations-Related Epilepsy in Pediatric Patients

Surgical Treatment and Long-Term Outcome of Cerebral Cavernous Malformations-Related Epilepsy in Pediatric Patients

A predicted model for postoperative seizure outcomes after the surgical resection of supratentorial cavernous malformations

The Role of Hemosiderin Excision in Seizure Outcome in Cerebral Cavernous Malformation Surgery: A Systematic Review and Meta-Analysis

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