Cavernous haemangiomas, epilepsy and treatment strategies.
BACKGROUND
Cavernous haemangiomas (cavernomas) are benign vascular malformations which can be found at any region within the central nervous system. Epilepsy is the most frequent manifestation of this malformation. Magnetic resonance imaging (MRI) used for the diagnostic evaluation of symptomatic seizures is a sensitive and specific method for the detection of cavernomas. Due to an increased application of MR imaging in the diagnostic evaluation of symptomatic seizures cavernomas have been found with increasing frequency over the past years. To achieve optimal treatment of patients with cavernous haemangiomas and epilepsy both medical and surgical treatment have to be considered.


OBJECTIVE
This paper reviews published studies and presents our own results concerning current treatment schedules of epileptogenic cavernomas.


RESULTS
In patients with intractable epilpesies surgical treatment of cavernomas seems to be the most successful antiepileptic therapy. Whether microsurgical lesionectomy, including the removal of only the cavernoma, or a more extensive resection is needed to achieve this aim are discussed.


CONCLUSIONS
New data acquired with high-resolution imaging (MRI, PET) and electrophysiology indicate that magnetencephalography (MEG) may contribute to the delineation of epileptogenic tissue bordering the lesion, thus permitting appropriate inclusion of this specific area within the resection, instead of performing a simple lesionectomy.
Stefan
H
H
Department of Neurology, Epilepsy Center Erlangen (ZEE), University Erlangen-Nuernberg, Erlangen, Germany. hermann.stefan@neuro.imed.uni-erlangen.de
Hammen
T
T
D004827:Epilepsy / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006392:Hemangioma, Cavernous / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D008866:Microsurgery / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D010347:Patient Care Planning; D049268:Positron-Emission Tomography