title: Microsurgical treatment of temporal lobe cavernomas.
abstract: BACKGROUND
  Cavernomas of the temporal lobe occur in 10-20% of patients with cerebral cavernomas. They frequently cause epileptic seizures, some of which tend to become refractory to medical therapy. Surgical removal of safely achievable symptomatic lesions has been frequently consistent with good long-term outcome. In the present study, a postoperative outcome is assessed.
  
  
  METHODS
  Of our 360 consecutive patients with cerebral cavernomas, 53 (15%) had a single cavernoma in the temporal lobe. Forty-nine patients were treated surgically and were included in the study. All data were analyzed retrospectively. The cavernomas were allocated into three groups based on the temporal lobe site: medial, anterolateral, and posterolateral. To collect follow-up data, all available patients were interviewed by phone. Seizure outcome was assessed using the Engel classification and general outcome using the Glasgow Outcome Scale (GOS).
  
  
  RESULTS
  Patients' median age at presentation was 37 (range, 7-64) years, with a female/male ratio of 2.5:1. Epileptic seizures occurred in 40 patients (82%). Median duration of seizures preoperatively was 3 (range, 0.1-23) years. In addition, four patients (10%) had memory disorder. Three patients without history of seizures (6%) complained of headache and two (4%) had memory problems. Three patients (6%) had an incidental cavernoma. Hemorrhage occurred in nine patients (18%) preoperatively. Median postoperative follow-up time was 6 (range, 0.2-26) years. Favorable seizure outcome (Engel class I and II) was registered in 35 patients (90%). Ten patients (25%) who had only a single seizure before surgery were seizure free during postoperative follow-up. Good general outcome (GOS, 4.5) was detected in 46 patients (96%). Two patients (4%) developed a new mild memory deficit after surgery, and in two patients existing memory deficits worsened.
  
  
  CONCLUSIONS
  Microsurgical removal of temporal lobe cavernomas is a safe and effective method to improve seizure outcome in patients with medically intractable epilepsy and to prevent deterioration caused by hemorrhage.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Finland. juri.kivelev@hus.fi
authors.forename: Juri
authors.initials: J
authors.lastname: Kivelev
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Göran
authors.initials: G
authors.lastname: Blomstedt
authors.forename: Reina
authors.initials: R
authors.lastname: Roivainen
authors.forename: Martin
authors.initials: M
authors.lastname: Lehecka
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery*; D002648:Child; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000601:surgery*; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods* / Q000639:trends; D008875:Middle Aged; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D055815:Young Adult