Abstracts

Rationale: There is at yet no consensus regarding optimal operative treatment for epileptogenic cavernous angiomas. The debate concerns whether patients with these lesions should be treated with lesionectomy alone or with the additional excision of nonlesional mesial temporal structures. The purpose of this study is to examine the clinical characteristics, surgical approach, and postoperative seizure control of patients with medically intractable temporal lobe epilepsy (TLE) who underwent operative treatment for epileptogenic cavernous angiomas located in the temporal lobe.Methods: We retrospectively evaluated six cases of surgically treated temporal epileptogenic cavernous angiomas for whom follow-up data were available. Six patients with medically intractable TLE underwent video EEG monitoring (VEM) at the UCLA Seizure Disorder Center demonstrating electroclinical seizure patterns congruent with radiographic lesion location. All underwent operation at UCLA by one neurosurgeon (I.F.) between 1998 and 2006 and had pathologically confirmed diagnoses of cavernous angioma. Data analyzed included the patients' clinical characteristics, diagnostic studies, operative approach, and postoperative seizure control.Results: Demographics included: 4/6 males, mean age at operation 46 years, mean epilepsy duration prior to operation 18 years. Temporal lobe location of cavernous angioma: 3/6 were located in the temporal neocortex, 3/6 mesial temporal. One patient had multiple cerebral cavernous angiomas with a solitary temporal lesion consistent with the VEM. For the three patients with temporal neocortical lesions, extended lesionectomy (EL) alone was performed, with sparing of the mesial temporal structures. The three patients with mesial temporal lesions underwent standardized anteromedial temporal resection (AMTR) combined with lesionectomy. Postoperative seizure outcome data for the six patients - three with EL alone and three with standardized AMTR + EL - had mean follow-up of 14 months (range 6 – 23 months). All six patients were Engel Class I; they had no seizures postoperatively while continuing their preoperative antiepileptic drug (AED) regimen. One patient had two seizures postoperatively, each occurring after AED discontinuation. One patient continued to have no seizures after discontinuing AEDs.Conclusions: The surgical approach to temporal epileptogenic cavernous angiomas should be guided not only by duration of epilepsy (as demonstrated in prior studies), but also by location of the lesion within the temporal lobe. Our results suggest that patients with cavernous angiomas located in the mesial temporal lobe will have excellent postoperative seizure control outcome when both the lesion and the mesial temporal structures are resected, whereas patients with temporal neocortical cavernous angiomas may be successfully treated with EL alone. However, the small number of cases and the lack of extended follow-up are limitations to this conclusion.