SURGICAL TREATMENT OF REFRACTORY EPILEPSY ASSOCIATED WITH SUPRATENTORIAL CAVERNOMA
Abstract number :
3.204
Submission category :
Year :
2002
Submission ID :
60
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Jose A. Burattini, Joaquim O. Vieira, Arthur Cukiert, Cassio R. Forster, Meire Argentoni, Cristine M. Baldauf, Valeria A. Mello, Leila Frayman, Carla Baise, Paulo T. Brainner-Lima. Neurology and Neurosurgery, Hospital Brigadeiro, Sao Paulo, Sao Paulo, Bra
RATIONALE: Cavernomas (CV) have been increasingly diagnosed as a cause of refractory epilepsy after the extensive use of MRI. Patients may bear single or multiple lesions.
METHODS: Eighteen patients with supratentorial CV were studied. Sixteen had single and 2 had 2 CV. Age ranged from 26 to 52 years and mean follow-up time was 1,9 years. Eight patients had temporal lobe CV (3 lateral and 5 mesial) and 4 of these patients (2 with lateral and 2 with mesial lesions) also had mesial temporal sclerosis (MTS). Four patients had parietal, 3 had frontal, 2 had occipital and 3 had insular lesions. Mean seizure[ssquote]s frequency was 2,2 / month. All patients with extratemporal CV were submitted to lesionectomy including the hemosiderotic periphery of the lesion. Three patients with temporal lobe cavernomas (1 mesial, 2 lateral) have been previously submitted to lesionectomy without amygdalo-hippocampectomy (AH) in other centers; all patients with temporal lobe CV were submitted to lesionectomy and AH, except for those previously operated who were submitted to AH only. AH was total in patients with MTS and comprised the anterior 2,0 cm of the hippocampus in patients with apparently normal mesial structures on MRI.
RESULTS: All patients except one with a parietal lesion have been rendered seizure-free after surgery. This patient with parietal CV had sporadic (1 every 2 months) seizures over the first 6 months postoperatively and then seizures disappeared. Transient (up to 3 weeks) dysphasia was noted in 2 patients: one with a left posterior temporal and one with a large inferior left parietal lesion.
CONCLUSIONS: Lesionectomy and resection of the hemosiderotic periphery is enough to abolish seizures in patients with extratemporal CV. In patients with temporal lobe CV, the response to such approach seems to yield poorer results and additional AH is recommended even in patients without associated MTS. Patients with non-dominant lesions have no major risk for memory decline. The 2,0 cm AH performed in this series in patients with dominant temporal lobe lesions and no MTS did not aggregate new verbal memory deficits.
[Supported by: Sao Paulo Secretary of Health]