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Meta-Analysis
. 2024 May 31;47(1):251.
doi: 10.1007/s10143-024-02491-0.

Surgical treatment of cavernous malformation-related epilepsy in children: case series, systematic review, and meta-analysis

Luca Bosisio  1 , Erica Cognolato  2 , Giulia Nobile  3 , Maria Margherita Mancardi  3 , Lino Nobili  2   3 , Mattia Pacetti  4 , Gianluca Piatelli  4 , Thea Giacomini  3 , Maria Grazia Calevo  5 , Martina Fragola  5 , Maria Sole Venanzi  6 , Alessandro Consales  4
Affiliations
Meta-Analysis

Surgical treatment of cavernous malformation-related epilepsy in children: case series, systematic review, and meta-analysis

Luca Bosisio et al. Neurosurg Rev. .

Abstract

Objective: Cerebral cavernous malformations (CCMs) are cerebral vascular lesions that occasionally occur with seizures. We present a retrospective case series from IRCCS Gaslini Children's Hospital, a systematic review, and meta-analysis of the literature with the goal of elucidating the post-surgery seizure outcome in children with CCMs.

Methods: a retrospective review of children with cavernous malformation related epilepsy who underwent surgery at Gaslini Children's Hospital from 2005 to 2022 was conducted. We also conducted a comprehensive search on PubMed/MEDLINE and Scopus databases from January 1989 to August 2022. Inclusion criteria were: presence of CCMs-related epilepsy, in under 18 years old subjects with a clear lesion site. Presence of post-surgery seizure outcome and follow-up ≥ 12 months.

Results: we identified 30 manuscripts and 223 patients with CCMs-related epilepsy, including 17 patients reported in our series. We identified 85.7% Engel class I subjects. The risk of expected neurological deficits was 3.7%; that of unexpected neurological deficits 2.8%. We found no statistically significant correlations between Engel class and the following factors: site of lesion, type of seizure, drug resistance, duration of disease, type of surgery, presence of multiple CCMs. However, we found some interesting trends: longer disease duration and drug resistance seem to be more frequent in subjects in Engel class II, III and IV; multiple cavernomas would not seem to influence seizure outcome.

Conclusions: epilepsy surgery in children with CCMs is a safe and successful treatment option. Further studies are necessary to define the impact of clinical features on seizure prognosis.

Keywords: Cavernous malformation; Epilepsy surgery; Pediatric epilepsy; Seizures.

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