GENERAL SCIENTIFIC SESSION II

Abstract

INTRODUCTION: Cavernous hemangiomas associated with epilepsy present an interesting surgical dilemma as to whether one should consider pure lesionectomy or tailored resection, especially in the temporal lobe given the potential for cognitive risk. This decision is often guided by electrocorticography (ECoG), despite the lack of data regarding its value in cavernoma surgery. The purpose of this study is several-fold: 1) to determine the epilepsy outcome after cavernoma resection in all brain regions, 2) to evaluate the usefulness of ECoG in guiding surgical decision making, and 3) to determine the optimum surgical approach for temporal lobe cavernomas. METHODS: One hundred and five of 173 patients undergoing surgical resection of cavernomas identified from our surgical database presented with epilepsy, with 61 harboring temporal lobe cavernomas. All patients were evaluated preoperatively by an epileptologist. Mean follow-up period was 37 months. RESULTS: Regardless of cavernoma location, surgery resulted in an excellent seizure control rate Engel Class I of 88% at 2 years. Of the 61 temporal lobe cavernomas, 35 involved the mesial structures. In the temporal lobe cavernomas, patients who had ECoG typically had a more extensive parenchymal resection than lesionectomy (P < 0.001). The use of ECoG in temporal lobe cavernomas resulted in a superior seizure-free outcome of 79% (n = 29) versus 91% (n = 23) at 6 months; 77% (n = 22) versus 90% (n = 20) at 1 year, and 79% (n = 14) versus 83% (n = 18) at 2 years for no ECoG versus ECoG, respectively. CONCLUSION: Surgical resection of cavernomas most often leads to an excellent epilepsy outcome. In temporal lobe cavernomas, the larger the resection as guided by ECoG, the better the seizure outcome. In addition to supporting the concept of kindling, this data advocates the use of ECoG for temporal lobe cavernoma surgery in patients presenting with epilepsy.