title: Epileptogenic temporal cavernous malformations: operative strategies and postoperative seizure outcomes.
abstract: Operative treatment of epileptogenic cavernous malformations (CM) continues under debate. Most studies focus on surgery for supratentorial CM in general. For temporal lobe CM, surgical decision-making concerns in particular whether to perform lesionectomy alone or the additional excision of mesial temporal structures. The purpose of this case series was to evaluate operative strategies used to treat epileptogenic temporal CM and to report resultant postoperative seizure outcomes. Twelve consecutive cases of patients with medically intractable epilepsy who underwent operation for temporal CM between 1996 and 2006 were retrospectively reviewed. When the temporal CM directly invaded the hippocampus or amygdala, the affected structures were resected in addition to the lesion; when the CM was located in the superficial temporal cortex, and there was no radiographic evidence of hippocampal sclerosis, lesionectomy alone was done; with CM located between the superficial temporal cortex and the mesial temporal region, other factors were considered in decision-making, such as lesion proximity to the deep mesiotemporal structures and preoperative epilepsy duration. For six of the twelve patients, extended lesionectomy (EL) alone was done; for the other six, tailored anteromedial temporal resection with hippocampectomy and/or amygdalectomy was performed in addition to EL. Postoperatively, 11 patients - all with preoperative VEM demonstrating electroclinical seizure patterns concordant with lesion location - were seizure-free. We conclude that epileptogenic temporal CM are surgically remediable, when approached with the above operative strategies and presurgical VEM. On the basis of these postoperative seizure control results, we recommend consideration of concurrent resection of mesial temporal structures with EL for certain temporal CM.
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA. kupchurchmd@gmail.com
authors.forename: Kristen
authors.initials: K
authors.lastname: Upchurch
authors.forename: John M
authors.initials: JM
authors.lastname: Stern
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.forename: Sandra
authors.initials: S
authors.lastname: Dewar
authors.forename: Jerome
authors.initials: J
authors.lastname: Engel
authors.forename: Harry V
authors.initials: HV
authors.lastname: Vinters
authors.forename: Itzhak
authors.initials: I
authors.lastname: Fried
mesh_terms: D000328:Adult; D000465:Algorithms; D000927:Anticonvulsants / Q000627:therapeutic use; D001165:Arteriovenous Malformations / Q000150:complications / Q000601:surgery*; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants