Abstracts

RATIONALE: Patients with supratentorial cavernous malformations who present with seizures may be treated with medical therapy alone, lesionectomy, or more extensive epilepsy surgery. This study evaluates the value of lesionectomy in patients presenting with either recent or chronic epilepsy. METHODS: This is a retrospective series of 62 consecutive patients followed for a mean of 52 months (minimum 6 months) after lesionectomy. RESULTS: Duration of epilepsy strongly correlated with outcome. All patients with seizures for < 2 months before surgery were seizure free. In contrast only 24/41 (58%) of patients with seizures >6 months were seizure free, with 6/41 Engel class II (15%), 6/41 (15%) class III, and 5/41 class IV (12%) (p<0.01). All 14 patients with only a single seizure remained seizure free; 13/16 patients with medication-controlled epilepsy were seizure free and 3 were in class II; in contrast (p=0.01) for patients with preoperative seizures continuing despite medications, only 16/31 (52%) were seizure free on followup, 4 (13%) were class II, 6 (19%) were class III, and 5 (16%) were class IV (p< 0.05). Temporal or parietal lobe lesion location was associated with worse seizure control after surgery than either frontal or occipital locations (p <0.05). CONCLUSIONS: Lesionectomy without formal epilepsy evaluation is appropriate for patients with a brief history of seizures (<2 months) and non-temporal, non-parietal lesion location. Risk factors for continued post-lesionectomy seizures include temporal or parietal lesions, epilepsy >