How serious is Cavernoma

gms | German Medical Science

Objective: The best surgical approach to treat epileptogenic cavernomas is still under controversy. We report on our retrospective series of 31 patients presenting with single or rare seizures in contrast to a medically intractable epilepsy associated with one or more supratentorial cavernomas and the outcome according to surgical treatment.

Methods: Thirty-one patients, 17 female and 14 male, aged 12-70 years (mean 37.39 years) with seizures and supratentorial cavernomas (multiple lesions in 5 patients) had been treated in our department (1993-2004). Frequency, duration and clinical pattern of seizures, cavernoma location, and antiepileptic drug regimen were examined. MRI, interictal scalp EEG, and angiography were performed in all cases. Surgery included lesionectomy alone (n = 19), tailored resection including the cavernoma (n = 11) and in one case of multiple cavernomas only resection of the inferior and medial temporal gyrus without cavernoma resection. Group A (n = 17, 55%) included patients with a low seizure frequency and short seizure history, and these were treated by lesionectomy alone. Group B (n = 9, 29%) included patients with medically intractable epilepsy, a high frequency and a long history of seizures. These patients were operated by tailored resection after additional preoperative evaluation (including ictal EEG with video monitoring; SPECT; WADA testing; neuropsychological testing). Five patients (16%) could not be included in any of these groups. Patients were followed for at least 12 months (mean 4.2 years).

Results: According to the criteria defined by ENGEL, 94% of the patients treated with lesionectomy alone (group A) had a favorable outcome (class I-II). All patients with only one seizure before surgery remained seizure free. The group of patients with medically intractable seizures (group B) also presented a favorable outcome in 90%, including one patient with multiple cavernomas, but no corresponding epileptogenic focus with one of the lesions (group C).

Conclusions: Based on our results, it is apparent that lesionectomy alone is sufficient in cases with only a single seizure and a short seizure duration. Patients with medically intractable seizures associated with cerebral cavernomas should be treated by tailored resection.