Abstract
Seizures are the most common presentation in patients with cerebral cavernous malformations (CCMs). Based on the hypothesis that the volume or proportion of gray matter (GM) displaced by CCMs is associated with the risk of seizure, we developed an algorithm by which to quantify the volume and proportion of displaced GM and the risk of seizure. Image analysis was conducted on 111 patients with solitary CCMs (divided into seizure and nonseizure groups) from our gamma knife radiosurgery (GKRS) database from February 2005 and March 2020. The CCM algorithm proved effective in quantifying the GM and CCM using T1WI MRI images. In the seizure group, 11 of the 12 patients exhibited seizures at the initial presentation, and all CCMs in the seizure group were supratentorial. The location of the limbic lobe within the CCM was significantly associated with the risk of seizure (OR = 19.6, p = 0.02). The risk of seizure increased when the proportion of GM displaced by the CCM exceeded 31%. It was also strongly correlated with the volume of displaced GM. The volume and proportion of displaced GM were both positively correlated with the risk of seizure presentation/development and thus could be used to guide seizure prophylaxis in CCM patients.
Highlights
Seizures are the most common manifestation of cerebral cavernous malformation (CCM) [1]
We developed an automated CCM algorithm capable of quantifying the gray matter (GM) and CCM in T1-weighted images (T1WI) magnetic resonance imaging (MRI) images from gamma knife radiosurgery (GKRS) plans with the aim of estimating the volume and proportion of GM displaced by the CCM
The locations of the 111 CCMs were classified via computerized image processing: lesions were found in the frontal lobe (15%), 2 in the temporal lobe (2.7%), 4 in the parietal lobe (3.5%), 2 in the occipital lobe (1.8%), in the sublobar region (15.9%), 3 in the limbic lobe (2.7%), 11 in the cerebellum (9.7%), and 54 in the brainstem (48.7%)
Summary
Seizures are the most common manifestation of cerebral cavernous malformation (CCM) [1]. In a prospective follow-up study, the annual incidence of seizure in patients with CCMs was estimated at 1.5% to 2.4% [2]. Cortical involvement and CCM location (supratentorial, archicortical, and mesiotemporal) have been identified as risk factors for seizures [2,3]. Researchers have identified cortical involvement as the most important risk factor for seizure development in cases of CCM. Mesiotemporal lobe involvement has been associated with an elevated risk of seizure development [2,6]. Researchers have yet to elucidate the relationship between the volume or proportion of cortical involvement and the risk of seizure risk.
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