Patient-assessed satisfaction and outcome after microsurgical resection of cavernomas causing epilepsy.
OBJECTIVE
Microsurgical resection of supratentorial cavernomas associated with intractable epilepsy is performed frequently. Despite its common occurrence, little is known about patient perceptions of microsurgical resection for cavernomas. This survey study was performed to investigate patient perceived outcome after surgery for cavernomas associated with intractable epilepsy.


METHODS
The authors' surgical database was searched for cavernoma resection performed between 1971 and July of 2006. Of the initial 173 patients identified, 102 met criteria for medically intractable seizures. These 102 patients were then mailed a survey to determine follow-up and patient satisfaction. Thirty-nine surveys were returned as undeliverable, and 30 (48%) of the remaining 63 patients responded.


RESULTS
The average age at surgery for patients responding to this survey was 40 +/- 16 years compared with 35 +/- 15 years for all 102 patients. At prolonged follow-up, 87% of patients reported being seizure-free. Of those with seizures, 2 (7%) reported being nearly seizure-free (rare disabling seizures), 2 (7%) believed they had a worthwhile improvement in seizure frequency, and no patient (0%) in this series believed they did not have a worthwhile improvement in seizure frequency. Ninety percent of responders stated they definitely, and 10% probably, would have surgery again. No patient responded that they probably or definitely would not have epilepsy surgery. Mean clinical follow-up was 36 +/- 8 months and survey follow-up was 97 +/- 13 months for these 30 patients. Use of the mail-in survey increased follow-up length 2.7 times longer compared with clinical follow-up.


CONCLUSIONS
It is clear from this select group of survey responders that patients undergoing surgery for cavernomas associated with medically intractable epilepsy are happy they underwent surgery (100%) and had excellent surgical outcomes (87% seizure-free) at prolonged follow-up of 97 +/- 13 months. These survey results support that microsurgical resection for cavernomas is highly effective and significantly improves these patients' quality of life.
Van Gompel
Jamie J
JJ
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Marsh
W Richard
WR
Meyer
Fredric B
FB
Worrell
Gregory A
GA
D000328:Adult; D001294:Attitude to Health; D003625:Data Collection / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D004827:Epilepsy / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006392:Hemangioma, Cavernous / Q000150:complications / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods* / Q000592:standards; D019635:Neurosurgical Procedures; D017060:Patient Satisfaction; D011788:Quality of Life; D015173:Supratentorial Neoplasms / Q000150:complications / Q000523:psychology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
Acta Neurochir Suppl. 1997;68:64-9
9233416
Appl Health Econ Health Policy. 2009;7(4):219-24
19905035
Med Care. 2006 Feb;44(2):167-74
16434916
Seizure. 2009 Sep;18(7):498-503
19428270
Epilepsy Res. 2008 Dec;82(2-3):133-8
18786810
Neurosurg Focus. 2006 Jul 15;21(1):e7
16859260
Neurosurgery. 2008 Feb;62(2):326-34; discussion 334-5
18382310
Neurosurgery. 1996 Jul;39(1):26-32; discussion 32-4
8805137
Epilepsy Res. 1993 Feb;14(2):175-82
8453953
Ann Neurol. 2007 Oct;62(4):327-34
17567854
Epilepsia. 2001 Feb;42(2):282-6
11240604
Seizure. 2009 Jan;18(1):14-20
18656386
J Neurosurg. 2009 Jun;110(6):1179-85
19216651
Epilepsy Behav. 2009 Jun;15(2):166-9
19250976
J Neurosurg. 2007 Sep;107(3):495-503
17886546
J Clin Epidemiol. 2008 Jun;61(6):609-10
18471665
Epilepsia. 2006 Mar;47(3):563-6
16529622
Neurosurgery. 2009 Jul;65(1):31-7; discussion 37-8
19574823
Neurosurgery. 2008 Nov;63(5):888-96; discussion 897
19005379
Neurol Sci. 2006 Feb;26(6):390-4
16601930
Clin Neurol Neurosurg. 1997 Aug;99(3):179-83
9350398
Neurosurgery. 2009 Sep;65(3):450-5; discussion 455
19687688