Surgical management and long-term outcome of pediatric patients with different subtypes of epilepsy associated with cerebral cavernous malformations

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Sufficient data on surgical treatment and seizure outcome of pediatric patients with different types of epilepsy, especially drug-resistant epilepsy and associated cerebral cavernous malformations, are scarce. The aim of this study was to carefully evaluate seizure outcome using the International League Against Epilepsy (ILAE) classification with regard to the presurgical symptom duration.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Fifty-one pediatric patients younger than 19 years with cerebral cavernous malformations of all CNS localizations have been surgically treated at the authors' institution. Twenty-two patients with seizures or epilepsy who harbored cortically located supratentorial cerebral cavernous malformations underwent surgical treatment and were retrospectively analyzed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>More extensive resections were used in 82% of all patients with epilepsy symptoms for longer than 2 years. Eighty-two percent of patients with symptom duration shorter than 2 years underwent circumscribed lesionectomy including the surrounding hemosiderotic rim. The overall rate of mild permanent, unanticipated postoperative deficits was 4.5%; the rate of anticipated neurological deficits was 9%. The mean follow-up was longer than 117 months in all groups. Seizure outcome was excellent in the group with symptom duration shorter than 2 years (100% ILAE Class 1). Seizure outcome was significantly worse in the group with longer symptom duration (p = 0.02). Seven patients were seizure free after surgery. Seizure outcome was stable over the years.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Since seizure outcome is worse with longer seizure duration, early surgery and, if needed, interdisciplinary intervention, is recommended. Even in cases of multiple cerebral cavernous malformations and epilepsy, surgery should be considered.</jats:p></jats:sec>

Paraventricular or centrum ovale cavernous hemangioma involving the pyramidal tract in children: intraoperative MRI and functional neuronavigation-guided resection

“…Preoperative pyramidal tract visualization, which demonstrates the 3D positional relationship between the lesion and the pyramidal tract, helps the neurosurgeon develop an optimal surgical approach. Some studies have confirmed the importance of preoperative visualization of functional structures in surgical planning [5,6,14,15,17]. In this study, the entire pyramidal tract was successfully reconstructed preoperatively, showing the 3D positional relationship between the lesion and the pyramidal tract.…”

Cavernous angiomas: deconstructing a neurosurgical disease

“…19 In patients with longstanding recalcitrant seizures, there is a better likelihood of seizure control if hemosiderin surrounding the lesion can be removed safely, and when resection of adjacent mesiotemporal structures is performed in cases with temporal lobe epilepsy and associated memory dysfunction or hippocampal atrophy. 7,11,80,101 Recent reports suggest a role for laser fiber ablation of CAs as a potentially promising treatment of associated epilepsy. 104 There are conflicting data on resection of a DVA associated with CA, with most authors advocating DVA preservation to prevent serious complications such as edema, hemorrhage, and/or venous infarctions.…”

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

“…Twenty-eight patients presenting nonepileptogenic symptoms such as hemorrhagic focal neurologic deficits, seizure, and headache were excluded. This study was approved by the institutional review board of Fuzhou General Hospital (No.2017- [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Written informed consents were obtained from all patients and their guardians.…”