Drug-resistant temporal lobe epilepsy due to cavernous malformations.
OBJECTIVE
Supratentorial cavernous angiomas may be associated with drug-resistant focal epilepsy. Surgical removal of the malformation may result in seizure control in a number of patients, although in most studies a long history and high frequency of attacks have been recognized as indicators of unfavorable seizure outcome. In the literature, there are no clear indications regarding the optimal diagnostic presurgical workup and the surgical strategy for this particular subgroup of patients with symptomatic epilepsy. In this paper the authors focus on the preoperative workup and the surgical management of the disease in eight consecutive patients undergoing surgery for drug-resistant temporal lobe epilepsy (TLE) due to cavernous malformations (CMs), and the relevant literature on this issue is also reviewed.


METHODS
Preoperatively, all patients were assessed using a noninvasive protocol aimed at localizing the epileptogenic zone on the basis of anatomical, electrical, and clinical criteria. The presurgical assessment yielded an indication for lesionectomy in two cases, lesionectomy plus anteromesial temporal lobectomy in four cases, and lesionectomy plus extended temporal lobectomy in two cases. At follow-up examinations, seizure, neuropsychological, and psychiatric outcomes were all evaluated. Seven patients were categorized in Engel Class IA (seizure free), and one was categorized in Engel Class IB (occasional auras only). No adverse effects on neuropsychological or psychosocial functioning were observed.


CONCLUSIONS
Epilepsy surgery can be performed with excellent results in patients with intractable TLE caused by CMs. Noninvasive presurgical evaluation of these patients may enable a tailored approach, providing complete seizure relief in most cases.
Paolini
Sergio
S
Department of Neurological Sciences, Epilepsy Surgery Unit, Neuromed Institute, Pozzilli, Italy. spao2@yahoo.com
Morace
Roberta
R
Di Gennaro
Giancarlo
G
Picardi
Angelo
A
Grammaldo
Liliana G
LG
Meldolesi
Giulio Nicolo
GN
Quarato
Pier Paolo
PP
Raco
Antonino
A
Esposito
Vincenzo
V
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D004351:Drug Resistance / Q000502:physiology; D004833:Epilepsy, Temporal Lobe / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000639:trends; D010348:Patient Care Team / Q000592:standards / Q000639:trends; D013702:Temporal Lobe / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000639:trends
D000927:Anticonvulsants