Seizure outcome after resection of cavernous malformations is better when surrounding hemosiderin-stained brain also is removed.
OBJECTIVE
Considering the epileptogenic effect of cavernoma-surrounding hemosiderin, assumptions are made that resection only of the cavernoma itself may not be sufficient as treatment of symptomatic epilepsy in patients with cavernous malformations. The purpose of this study was to test the hypothesis whether seizure outcome after removal of cavernous malformations may be related to the extent of resection of surrounding hemosiderin-stained brain tissue.


METHODS
In this retrospective study, 31 consecutive patients with pharmacotherapy-refractory epilepsy due to a cavernous malformation were included. In all patients, cavernomas were resected, and all patients underwent pre- and postoperative magnetic resonance imaging (MRI). We grouped patients according to MRI findings (hemosiderin completely removed versus not/partially removed) and compared seizure outcome (as assessed by the Engel Outcome Classification score) between the two groups.


RESULTS
Three years after resection of cavernomas, patients in whom hemosiderin-stained brain tissue had been removed completely had a better chance for a favorable long-term seizure outcome compared with those with detectable postoperative hemosiderin (p=0.037).


CONCLUSIONS
Our study suggests that complete removal of cavernoma-surrounding hemosiderin-stained brain tissue may improve epileptic outcome after resection of cavernous malformations.
Baumann
Christian R
CR
Department of Neurology, University Hospital, Zürich, Switzerland.
Schuknecht
Bernhard
B
Lo Russo
Giorgio
G
Cossu
Massimo
M
Citterio
Alberto
A
Andermann
Frederick
F
Siegel
Adrian M
AM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000378:metabolism* / Q000473:pathology / Q000601:surgery*; D002426:Cavernous Sinus / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D004351:Drug Resistance; D004827:Epilepsy / Q000378:metabolism / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006485:Hemosiderin / Q000378:metabolism*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D000927:Anticonvulsants; D004396:Coloring Agents; D006485:Hemosiderin