EPILEPTOGENIC TEMPORAL CAVERNOUS MALFORMATIONS CASE SERIES: OPERATIVE STRATEGIES AND POSTOPERATIVE SEIZURE OUTCOMES
Abstract number :
2.278
Submission category :
9. Surgery
Year :
2008
Submission ID :
9300
Source :
www.aesnet.org
Presentation date :
12/5/2008 12:00:00 AM
Published date :
Dec 4, 2008, 06:00 AM
Authors :
K. Upchurch, J. Stern, Noriko Salamon, H. Vinters, Igor Veshchev, S. Dewar, N. Gonzalez, J. Engel Jr. and I. Fried
Rationale: Surgical treatment of patients with epileptogenic cavernous malformations (CM) continues to be debated. Most studies focus on the outcomes of surgery for supratentorial CM in general, with few addressing the details of operative planning for CM according to their specific anatomic location. For CM located in the temporal lobe, surgical decision-making concerns whether patients with these lesions should be treated with lesionectomy alone or with the additional excision of mesial temporal structures. The purpose of this case series was to investigate the clinical data used to design operative strategies for the treatment of epileptogenic temporal CM and the resultant postoperative seizure outcomes. Methods: The clinical and operative data of fifteen consecutive patients with medically intractable epilepsy who underwent operation for temporal CM between 1996 and 2006 by one surgeon (I.F.) were retrospectively reviewed. All patients underwent preoperative video EEG monitoring (VEM) and subsequent resection with pathologically confirmed diagnosis of CM. Results: For 8 of the 15 patients, extended lesionectomy (EL) alone was done, with sparing of the mesial temporal structures. For 7 of the 15 patients, tailored variations of anteromedial temporal resection with hippocampectomy and/or amygdalectomy were performed, in combination with EL. Postoperatively, 14 patients - all with preoperative VEM demonstrating electroclinical seizure patterns congruent with the location of the subsequently resected lesion - were seizure-free (Engel Class I). One patient with EEG findings suggestive of bilateral independent temporal epileptogenic zones had no postoperative change in epilepsy status (Engel Class IV). (Mean follow-up 42 months; range 12 - 120 months). Conclusions: Our results demonstrate that - with careful presurgical evaluation and operative strategy - epileptogenic CM located in the temporal lobe are surgically remediable. The detailed data that we report regarding surgical decision-making and outcomes in fifteen consecutive cases may be useful for designing successful operative strategies for temporal CM and for counseling patients with these lesions.
Surgery