title: Surgical outcome in patients with epilepsy with occult vascular malformations treated with lesionectomy.
abstract: OBJECTIVE
  This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
  
  
  METHODS
  Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
  
  
  RESULTS
  Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
  
  
  CONCLUSIONS
  Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.
authors.affiliation: Swedish Epilepsy Center, Seattle, Washington 98122, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Kraemer
authors.forename: M L
authors.initials: ML
authors.lastname: Griebel
authors.forename: N
authors.initials: N
authors.lastname: Lee
authors.forename: A H
authors.initials: AH
authors.lastname: Friedman
authors.forename: R A
authors.initials: RA
authors.lastname: Radtke
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006485:Hemosiderin; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D008032:Limbic System / Q000000981:diagnostic imaging; D008297:Male; D019579:Neocortex / Q000000981:diagnostic imaging / Q000601:surgery*; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome
chemical_list: D006485:Hemosiderin