| Intracranial Cavernous Malformations and Seizure Control : A 3-Year Single Center Study |
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Jae Jon Sheen, Seok Ho Hong, Jae Sung Ahn, Byung Deok Kwun, Jeong Hoon Kim, Dooh Hoon Kwon |
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Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea |
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| Abstract |
Objective
To characterize the clinical features and results of treatment for seizure-associated cerebral cavernous malformations (CCM).
Materials and Methods: We retrospectively analyzed the clinical features of 98 patients (46 men, 52 women) with CCM diagnosed by magnetic resonance imaging (MRI) or histology between January 2011 and December 2013 at a single institution. Analyzed data included patient age, sex, post-treatment mean follow-up period, smoking, diabetes mellitus, hypertension, headache, hemorrhage, and location of the CCM. Treatment modalities were classified into microsurgical resection, gammaknife radiosurgery (GKRS) and non-surgery with receipt of Anti-Epileptic Drugs (AED). We used the International League against Epilepsy (ILAE) classification to evaluate post-treatment seizure outcomes.
Results
CCM on the motor strip of the frontal lobe had the highest freqeuncy of seizures (66.7%, 6 of 9 patients), followed by the temporal lobe and the non-motor strip (p=0.000). Seizure outcomes after microsurgical resection were excellent since ILAE Class 1 was achieved in 10 of the 12 patients (83.33%). After GKRS, 2 (66.7%) of three patients were in class 1 whereas none of the patients treated with AED alone, were in class 1. Seizure outcomes were worse in GKRS than microsurgical resection, but better than without any surgery (p=0.002).
Conclusions
Motor strip lesions are the most likely to be epileptogenic. Microsurgical resection is an effective and safe therapy for patients with seizure-associated CCM and remains the optimal treatment for CCM. Radiosurgery can be used for either eloquent or deep-seated CCM. |
| Key Words:
Cerebral cavernous malformation, Epilepsy, Epileptic seizures, Gamma knife radiosurgery, Hemorrhage, Seizures. |
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