Treatment and Outcome of Epileptogenic Temporal Cavernous Malformations

• Published in: Chinese medical journal Vol. 128; no. 7; pp. 909 - 913
• Main Authors: Shan, Yong-Zhi, Fan, Xiao-Tong, Meng, Liang, An, Yang, Xu, Jian-Kun, Zhao, Guo-Guang
• Format: Journal Article
• Language: English
• Published: China Medknow Publications Pvt Ltd 05.04.2015; Medknow Publications and Media Pvt. Ltd; Lippincott Williams & Wilkins Ovid Technologies; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Medknow Publications & Media Pvt Ltd; Wolters Kluwer
• Subjects: Adolescent; Adult; Care and treatment; Cavernous Malformation; Electrocorticogram; Epilepsy; Surgery; Temporal Lobe; Child; Convulsions & seizures; Drug resistance; Electrodes; Electroencephalography; Epilepsy; Epilepsy - surgery; Female; Hemangioma, Cavernous, Central Nervous System - surgery; Hospitals; Humans; Male; Medical imaging; Middle Aged; Neurosurgery; NMR; Nuclear magnetic resonance; Original; Patient outcomes; Retrospective Studies; Surgical outcomes; Temporal Lobe - pathology; Temporal Lobe - surgery; Treatment Outcome; Young Adult; China; Temporal Lobe; Electrocorticogram; Cavernous Malformation; Epilepsy; Surgery
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.154289

Background: The aim of this study is to explore the treatment and outcome of epileptogenic temporal lobe cavernous malformations (CMs). Methods: We analyzed retrospectively the profiles of 52 patients diagnosed as temporal lobe CMs associated with epilepsy. Among the 52 cases, 11 underwent a direct resection of CM along with the adjacent zone of hemosiderin rim without electrocorticogram (ECoG) monitoring while the other 41 cases had operations under the guidance of ECoG. Forty-six patients were treated by lesionectomy + hemosiderin rim while the other six were treated by lesionectomy + hemosiderin rim along with extended epileptogenic zone resection. The locations of lesions, the duration of illness, the manifestation, the excision ranges and the outcomes of postoperative follow-up were analyzed, respectively. Results: All of the 52 patients were treated by microsurgery. There was no neurological deficit through the long-term follow-up. Outcomes of seizure control are as follows: 42 patients (80.8%) belong to Engel Class I, 5 patients (9.6%) belong to Engel Class II, 3 patients (5.8%) belong to Engel Class III and 2 patients (3.8%) belong to Engel Class IV. Conclusion: Patients with epilepsy caused by temporal CMs should be treated as early as possible. Resection of the lesion and the surrounding hemosiderin zone is necessary. Moreover, an extended excision of epileptogenic cortex or cerebral lobes is needed to achieve a better prognosis if the ECoG indicates the existence of an extra epilepsy onset origin outside the lesion itself.