Microsurgical Treatment Of Temporal Cerebral Cavernous Malformations Associated With Seizures

Cerebral cavernous malformations (CCMs) are vascular malformations with an estimated prevalence of0.5%in population, with approximately20%discovered in the temporal lobe. CCMs are often described as well circumscribed sinusoid lesions filled with blood and lined with endothelium without interposed brain parenchyma. Patients with CCMs have a high risk for developing epileptic seizures. CCMs in temporal lobe are considered to be more epileptogenic than lesions in other locations. Other neurologic symptoms are intracranial hemorrhages, focal neurologic deficits, and chronic headache. Surgical management is often considered the definitive treatment of choice. However, the focus of most existing research is on outcome of surgically treated patients with seizures due to supratentorial CCMs, and studies particularly for CCMs in temporal lobe are very limited.ObjectiveThe aim of the present study was to assess postoperative outcome of temporal CCMs associated with seizures.MethodsWe retrospectively studied24patients who underwent microsurgical resection of temporal CCMs associated with seizures. The patients were divided into traditional neurosurgery and epiletic surgery group. Eleven of the patients were treated in the way of traditional neurosurgery and the other thirteen patients were handled in the way of epiletic surgery. All patients were interviewed by phone or clinical visits. Seizure outcome was assessed using the Engel classification and general outcome using the modified Rankin Scale (mRS). Outcome of the two group were then compared.ResultsThe mean follow-up of traditional neurosurgery group was42.5±17.5months (range,25-81months). At time of last available follow-up,7(63.6%) patients were classified as Engel class I,2(10.5%) patients had rare seizures (Engel class II), and2(10.5%) patients continued to have frequent seizures (Engel class III-IV). After a mean follow-up period of15.9±4.2months (range,12-27months) in epiletic surgery group, all the patients (100%) were categorized as Engel class I. Favorable outcome (mRS class0and1) was seen in all the patients. Seven patients developed a new mild memory deficit after surgery and they were all from epiletic surgery group.ConclusionsIf treated in a way of epiletic surgery, postoperative seizure-free status can be expected in100%of patients with temporal CCMs and prior seizures. The analysis of outcome showed that patients benefited more from the way of epiletic surgery than traditional neurosurgery.