Treatment and outcome of epileptogenic temporal cavernous malformations

Abstract

Background: The aim of this study is to explore the treatment and outcome of epileptogenic temporal lobe cavernous malformations (CMs).

Methods: We analyzed retrospectively the profiles of 52 patients diagnosed as temporal lobe CMs associated with epilepsy. Among the 52 cases, 11 underwent a direct resection of CM along with the adjacent zone of hemosiderin rim without electrocorticogram (ECoG) monitoring while the other 41 cases had operations under the guidance of ECoG. Forty-six patients were treated by lesionectomy + hemosiderin rim while the other six were treated by lesionectomy + hemosiderin rim along with extended epileptogenic zone resection. The locations of lesions, the duration of illness, the manifestation, the excision ranges and the outcomes of postoperative follow-up were analyzed, respectively.

Results: All of the 52 patients were treated by microsurgery. There was no neurological deficit through the long-term follow-up. Outcomes of seizure control are as follows: 42 patients (80.8%) belong to Engel Class I, 5 patients (9.6%) belong to Engel Class II, 3 patients (5.8%) belong to Engel Class III and 2 patients (3.8%) belong to Engel Class IV.

Conclusion: Patients with epilepsy caused by temporal CMs should be treated as early as possible. Resection of the lesion and the surrounding hemosiderin zone is necessary. Moreover, an extended excision of epileptogenic cortex or cerebral lobes is needed to achieve a better prognosis if the ECoG indicates the existence of an extra epilepsy onset origin outside the lesion itself.

Figure 1

HE×250 Postoperative histological figure: High power view shows tumor tissue is composed of high expansion blood sinus, lined with thin wall flat endothelial cells, a few fibrous tissue separation between blood sinus, some area with visible red blood cells and hemosiderin deposition.

Figure 2

Preoperative MRI scans of a 12-year-old girl with intractable epilepsy. A cerebral cavernous angioma with perilesional hemosiderin deposits was detectable in a right-sided mesiotemporal location.

Figure 3

Preoperative MRI scans on T1-weighted images with a little contrast enhancement in the parenchymal part of the lesion after administration of intravenous gadolinium.

Figure 4

The ECoG showed the spikes on the electrodes inserted into the right temporal base. (0.5Hz-70Hz,800uV/cm)

Figure 5

After the removal of lesion and HR, ECoG with the depth electrodes puncture in hippocampus still demonstrate significant epileptic discharges which led to resect of the mesial part of temporal lobes.