Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations

Document Type

Article

Abstract

OBJECT: Seizures are the most common presenting symptom of supratentorial cerebral cavernous malformations (CCMs) and progress to medically refractory epilepsy in 40% of patients. Predictors of seizure freedom in the resection of CCMs are incompletely understood. METHODS: The authors systematically reviewed the published literature on seizure freedom following the resection of supratentorial CCMs in patients presenting with seizures. Seizure outcomes were stratified across 12 potential prognostic variables. A total of 1226 patients with supratentorial CCMs causing seizures were identified across 31 predominantly retrospective studies; 361 patients had medically refractory epilepsy. RESULTS: Seventy-five percent of the patients were seizure free after microsurgical lesion removal, whereas 25% continued to have seizures. All patients had had preoperative seizures and > 6 months of postoperative follow-up. Modifiable predictors of postoperative seizure freedom included gross-total resection (OR 36.6, 95% CI 8.5-157.5) and surgery within 1 year of symptom onset (OR 1.83, 95% CI 1.30-2.58). Additional prognostic indicators of a favorable outcome were a CCM size < 1.5 cm (OR 15.4, 95% CI 5.2-45.4), the absence of multiple CCMs (OR 2.02, 95% CI 1.13-3.60), medically controlled seizures (OR 2.38, 95% CI 1.29-4.39), and the lack of secondarily generalized seizures (OR 3.33, 95% CI 2.09-5.30). Other factors, including extended resection of the hemosiderin ring, were not significantly predictive. CONCLUSIONS: In the surgical treatment of supratentorial CCMs, gross-total resection and early operative intervention may improve seizure outcome. While surgery should not be considered the first-line treatment for CCM-related epilepsy, it is important to understand the variables associated with seizure freedom in CCM resection given the considerable morbidity and diminished quality of life associated with epilepsy.

Medical Subject Headings

Adolescent; Adult; Epilepsy (diagnosis, epidemiology); Female; Hemangioma, Cavernous, Central Nervous System (epidemiology, surgery); Humans; Male; Morbidity; Postoperative Complications (diagnosis, epidemiology); Predictive Value of Tests; Prognosis; Retrospective Studies; Young Adult

Publication Date

8-9-2011

Publication Title

Journal of neurosurgery

E-ISSN

1933-0693

Volume

115

Issue

6

First Page

1169

Last Page

74

PubMed ID

21819194

Digital Object Identifier (DOI)

10.3171/2011.7.JNS11536

This document is currently not available here.

Share

COinS