Seizure outcome after resection of supratentorial cavernous malformations: a study of 168 patients.
OBJECTIVE
The optimal management of cerebral cavernous malformations (CCMs) with epileptic seizures is still a matter of debate. The aim of our study was to examine seizure outcome in the largest published series of surgically treated patients with epilepsy due to a supratentorial CCM, and to define predictors for good surgical outcome.


METHODS
We retrospectively studied 168 consecutive patients with a single supratentorial CCM and symptomatic epilepsy in a multicenter study. Pre- and postoperative clinical examinations, age at epilepsy onset, age at operation, type of symptoms due to the CCM (seizures, headache, hemorrhage, focal deficits), type and frequency of epileptic seizures, and the localization and size of the CCM were assessed. Seizure outcome was determined in the first, second, and third postoperative years.


RESULTS
The CCM was completely resected in all patients. More than two thirds of the patients were classified as seizure free in the first 3 postoperative years. Predictors for good seizure outcome were age older than 30 years at the time of surgery, mesiotemporal CCM localization, CCM size <1.5 cm, and the absence of secondarily generalized seizures. No mortality occurred in our series, but only mild postoperative neurologic deficits in 12 (7%) patients.


CONCLUSIONS
Considering the natural history of CCMs, the favorable neurologic and seizure outcome, surgical resection of CCMs should be considered in all patients with supratentorial CCMs and concomitant epilepsy, irrespective of the presence or absence of predictors for a favorable seizure outcome.
Baumann
Christian R
CR
Department of Neurology, University Hospital, Zurich, Switzerland.
Acciarri
Nicola
N
Bertalanffy
Helmut
H
Devinsky
Orrin
O
Elger
Christian E
CE
Lo Russo
Giorgio
G
Cossu
Massimo
M
Sure
Uli
U
Singh
Anuradha
A
Stefan
Hermann
H
Hammen
Tilo
T
Georgiadis
Dimitrios
D
Baumgartner
Ralf W
RW
Andermann
Frederick
F
Siegel
Adrian M
AM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D018572:Disease-Free Survival; D004827:Epilepsy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011379:Prognosis; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome