Surgical management and long-term outcome of pediatric patients with different subtypes of epilepsy associated with cerebral cavernous malformations.
OBJECTIVE
Sufficient data on surgical treatment and seizure outcome of pediatric patients with different types of epilepsy, especially drug-resistant epilepsy and associated cerebral cavernous malformations, are scarce. The aim of this study was to carefully evaluate seizure outcome using the International League Against Epilepsy (ILAE) classification with regard to the presurgical symptom duration.


METHODS
Fifty-one pediatric patients younger than 19 years with cerebral cavernous malformations of all CNS localizations have been surgically treated at the authors' institution. Twenty-two patients with seizures or epilepsy who harbored cortically located supratentorial cerebral cavernous malformations underwent surgical treatment and were retrospectively analyzed.


RESULTS
More extensive resections were used in 82% of all patients with epilepsy symptoms for longer than 2 years. Eighty-two percent of patients with symptom duration shorter than 2 years underwent circumscribed lesionectomy including the surrounding hemosiderotic rim. The overall rate of mild permanent, unanticipated postoperative deficits was 4.5%; the rate of anticipated neurological deficits was 9%. The mean follow-up was longer than 117 months in all groups. Seizure outcome was excellent in the group with symptom duration shorter than 2 years (100% ILAE Class 1). Seizure outcome was significantly worse in the group with longer symptom duration (p = 0.02). Seven patients were seizure free after surgery. Seizure outcome was stable over the years.


CONCLUSIONS
Since seizure outcome is worse with longer seizure duration, early surgery and, if needed, interdisciplinary intervention, is recommended. Even in cases of multiple cerebral cavernous malformations and epilepsy, surgery should be considered.
Departments of Neurosurgery and.
Christian
C
von der Brelie
Stefan
S
Kuczaty
Marec
M
von Lehe
D000293:Adolescent; D002540:Cerebral Cortex / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
AED = antiepileptic drug; CCM = cerebral cavernous malformation; EEG = electroencephalography; ILAE = International League Against Epilepsy; cerebral cavernous malformation; epilepsy; outcome; pediatric; surgery