Abstracts

Rationale: The surgical treatment for patients presenting seizure with cavernous angioma (CA) is the best treatment strategy. However, the optimal extent of presurgical intervention in patients with CA is not well defined. The aim of this study was to investigate the optimal extent of presurgical evaluation in patients with CA.Methods: We enrolled the consecutive 39 patients with CA who underwent surgical treatment. One patient was excluded due to follow up loss. We divided them into 3 groups. Group I was comprehensive study group who underwent video-EEG monitoring with functional imaging study including 18F-FDG PET or 99mTc-ECD SPECT and if needed, invasive EEG study including subdural and/or depth electrodes. Ictal-interictal SPECT substraction was performed. Group II was video-EEG monitoring group without functional imaging study. Group III was surgery group without video-EEG monitoring or functional image study. The percentage of good surgical outcome (Engel class I or II) was compared between these 3 groups.Results: Finally, 38 patients were included in the analysis (CA in temporal lobe 32, in frontal lobe 3, in parietal lobe 2, in occipital lobe 1, in frontotemporal lobe 1). 18 out of 38 patients were male (46.2%). In Group I, the comprehensive study group (n=30), mean duration from epilepsy onset to surgery was 7.1±4.9 yr. Locations of the lesion were temporal in 28, and frontotemporal in 1, occipital 1. Twenty seven had Wada to determine memory dominance. Invasive EEG study was done in 29 patients (96.7%) to localize the epileptogenic zone. 27 patients underwent anterior temporal lobectomy (ATL) including lesion with or without tailored amygdalohippocampectomy (AH), 6 of them did simple lesionectomy, and 2 patient had cortisectomy including lesion. 28 patients (93.4%) showed good surgical outcome. In group II (n=4) mean duration from epilepsy onset to surgery was 6.2±8.0 yr. Locations of the lesion were temporal in 2, frontal in 2. 2 patients with frontal and 2 temporal lesions conducted subdural grid insertions. 3 patients underwent simple lesionectomy after invasive EEG study, and 1 had cortisectomy including lesion. 4 patients (100%) showed good surgical outcome. In Group III (n=4), mean duration from epilepsy onset to surgery was 6.5±11.0 yr. Lesions were located in temporal lobe in 1, in frontal lobe in 1, and parietal lobe in 2 patient. . patients underwent cortisectomy and 1 did ATL including lesion with ECoG-guided AH. Surgical outcome was good in 4 patients (100%). The percentage of patients who showed good surgical outcome was 94.7% (36 of 38) as a whole and the surgical outcome was not different among 3 groups (p=0.865).Conclusions: Surgical outcome of epilepsy with CA was generally good in our patients. Simple lesionectomy alone might be enough in selected patient of extra-temporal lesion especially with short duration of epilepsy. However, more comprehensive pre-surgical interventions should be administrated in patients with long history of epilepsy with CA especially in temporal lobe lesion.