Seizure characteristics and control after microsurgical resection of supratentorial cerebral cavernous malformations.
OBJECTIVE
The optimal management of seizures associated with cerebral cavernous malformations (CCMs) is unclear. The aim of this study was to determine the efficacy of surgery in the management of CCM-associated seizures.


METHODS
We conducted a retrospective review with follow-up of 164 patients who underwent microsurgical resection of supratentorial CCMs. Clinical and radiographic data were collected and then analyzed to determine predictors of developing epilepsy and predictors of postoperative seizure control after microsurgical resection.


RESULTS
Of the patients, 61.5% presented with seizures, and 34.7% had clinically defined epilepsy. The development of epilepsy was associated with CCMs located in the temporal lobe and the absence of symptomatic hemorrhage. After microsurgical resection in 44 patients with intractable epilepsy, 72.7% were completely seizure-free (Engel class 1), 11.4% had rare seizures (Engel class 2), 4.5% had meaningful improvement (Engel class 3), and 11.4% had no improvement (Engel class 4). Predictors of complete seizure freedom were gross total resection, smaller CCMs, and the absence of secondary generalized seizures (94% of patients were seizure-free with all 3 predictors).


CONCLUSIONS
Surgery is a safe and effective treatment for seizures associated with CCMs.
Chang
Edward F
EF
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143, USA. ChangEd@neurosurg.ucsf.edu
Gabriel
Rodney A
RA
Potts
Matthew B
MB
Garcia
Paul A
PA
Barbaro
Nicholas M
NM
Lawton
Michael T
MT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult