Abstracts

Cavernomas (cavernous hemangiomas, cavernous angiomas) account for 5-20% of all cerebrovascular malformations. Seizures, clinically significant bleedings and focal neurological deficits are the most common manifestations of symptomatic cerebral cavernomas. To date there exist no general guidelines for the optimal management of cerebral cavernomas and epilepsy. We present our preliminary data on a retrospective analysis of surgically treated patients with symptomatic epilepsy due to cerebral cavernomas. Conservatively treated patients are under investigestion.
Surgically treated patients with symptomatic seizures/epilepsy due to MRI documented cerebral cavernomas were included. We retrospectively analysed patient and disease/lesion dependent factors (age at last follow up, age at seizure onset, gender, family history, duration of epilepsy, seizure frequency, localisation, number and size of cavernoma). Diagnostic and therapeutic means (brain imaging, follow up of brain imaging, surgical approach, post-operative outcome and follow up) were studied. Conservatively treated patients are under investigation.
Fourteen patients (f=8, m=6) were included. Median age at seizure onset was 38 yrs (range, 19-64 yrs). Four patients each had temporal lobe epilepsy respectively frontal lobe epilepsy, five parietal lobe epilepsy and one occipital lobe epilepsy. Median duration of epilepsy was five months (range, [lt]1-204 mo). Twelve patients exhibited singular lesions, whereas two had multiple cerebral cavernomas. Considering postoperative MRI scans which were performed in nine patients, showed a persisting hemosiderin ring in seven. Twelve out of fourteen patients showed a very favourable postoperative outcome with seizure freedom (Engel`s class Ia, Wieser`s class I) during a median follow up period of seven months (range, 1-48 mo).
About 86% of surgically treated patients with symptomatic seizures/epilepsy due to cerebral cavernomas were seizure free postoperatively (Engel`s class Ia, Wieser`s class I). The only predicting factor for a less favourable postoperative outcome was the presence of multiple cerebral lesions. To evaluate the optimal treatment for symptomatic epilepsies due to cerebral cavernomas prospective studies of conservatively and surgically treated patients are needed.