Influence Factors Analysis Of Seizure After Cavernous Malformation Operation

PartⅠA predicted model for postoperative seizure outcomes after the surgical resection of supratentorial cavernous malformationsBackground and Purpose:Various presurgical factors are associated with postsurgical outcomes in cavernous malformation treatment.Aim of this study is to examine predictive model to correlate presurgical factors and postsurgical outcomes.Methods:This is retrospective,single centered study of supratentorial cavernous malformations associated with seizures subsequently treated with microsurgical resection.Presurgical parameters including age at onset,gender,seizure duration,seizure number,seizure characteristics,lesion location,size and residual hemosiderin rim was analyzed in univariate using Pearson chi-squared test,continuity correction or Fisher test and multivariable logistic regression model to test the association of the predictors and post surgical seizure outcome.Results:Forty-three patients meeting inclusion criteria was grouped into Engel class Ⅰ(n=34)and Engel class Ⅱ-Ⅳ(n=9).Poor postsurgical seizure freedom was consociated with Seizure frequency(x2=13.440,P=0.004)and seizure duration(x2=5.145,P=0.023)in univariate analysis.Preoperative seizure frequency was potent predictor(P=0.004)on multivariable logistic regression analysis.And remaining presurgical parameters including seizure characteristics,age at onset,gender,consumption of medicines,smoking and family history were not related to postsurgical seizure freedom.The receiver operating characteristic curve revealed that presented equation is potent predictor of postsurgical seizure freedom(95%confidence interval 0.709-0.957,P=0.002).Conclusions:History of higher seizure frequency in cerebral cavernous malformations has a poor postoperative seizure freedom.To shorten history of seizure frequency and better seizure control,early surgery is recommended.Part II The Role of Hemosiderin Excision in Seizure Outcome in Cerebral Cavernous Malformation Surgery:Meta-AnalysisBackground and Purpose:It is still unknown that whether the excision of hemosiderin surrounding cerebral cavernous malformations(CCMs)is benefit for obtaining a seizure-free outcome.Here,we performed a meta-analysis to evaluate the effect of hemosiderin ring resection on seizure outcome in CCM patients.Methods:PubMed,Web of Science and EBSCO databases were searched for surgical treated cavernous malformations comparing lesionectomy and lesionectomy along with hemosiderin ring resection.Ten studies fulfilling the inclusion and exclusion criteria were extracted.Meta-analyses and subgroup analyses were performed to find out correlation of hemosiderin ring resection and postoperative seizure control.Results:Extended hemosiderin ring resection was associated with improved seizure outcome(OR,0.62;95%CI:0.42-0.91;P = 0.01).Subgroup analysis showed that longer seizure duration,male dominant studies,Asian countries,studies with low cases of multiple CCMs,cohort studies,lesion size greater than 2cm,follow up less than 3 years were associated with significantly better surgical outcome for extended hemosiderin rim group.Sensitivity analysis indicated that the relationship between hemosiderin excision and seizure outcome was robust.Conclusions:Complete hemosiderin ring resections have significantly better seizure outcomes than lesionectomy alone.But randomized controlled trials with more patients are still needed to confirm our result.