Abstract
Cerebral cavernous malformations (CMs) are dynamic lesions characterized by continuous size changes and repeated bleeding. When involving cortical tissue, CMs pose a significant risk for the development of drug-resistant epilepsy, which is thought to be result of an altered neuronal network caused by the lesion itself and its blood degradation products. Preoperative evaluation should comprise a complete seizure history, neurological examination, epilepsy-oriented MRI, EEG, video-EEG, completed with SPECT, PET, functional MRI, and/or invasive monitoring as needed. Radiosurgery shows variable rates of seizure freedom and a high incidence of complications, thus microsurgical resection remains the optimal treatment for CMs presenting with drug-resistant epilepsy. Two thirds of patients reach Engel I class at 3-year follow-up, regardless of lobar location. Those with secondarily generalized seizures, a higher seizure frequency, and generalized abnormalities on preoperative or postoperative EEG, show poorer outcomes, while factors such as gender, duration of epilepsy, lesion size, age, bleeding at the time of surgery, do not correlate consistently with seizure outcome. Electrocorticography and a meticulous removal of all cortical hemosiderin – beyond pure lesionectomy – reduce the risk of symptomatic recurrences.
Highlights
Cerebral cavernous malformations (CMs), known as cavernous angiomas, cavernomas, or cavernous hemangiomas, were first described in the central nervous system by Virchow in 1863 (Iza-Vallejo et al, 2005) and characterized microscopically by Mccormick (1966)
Spin echo and gradient echo sequences using T1 and T2-weighed MRI provide useful information on the CM hemodynamics; and permit to classify them in four types according to the findings focused on signal characteristics (Zabramski et al, 1994)
Yeon et al (2009) found no difference between lesionectomy and other methods; but the decision of what procedure to perform was predetermined by their protocol, which, in turn favors the use of a more aggressive approach for patients with intractable epilepsy, a group in which blood degradation products are thought to play a major role in the aforementioned mechanisms of seizure propagation and secondary epileptogenesis (Morrell, 1991; Yeh and Privitera, 1991)
Summary
Cerebral cavernous malformations (CMs), known as cavernous angiomas, cavernomas, or cavernous hemangiomas, were first described in the central nervous system by Virchow in 1863 (Iza-Vallejo et al, 2005) and characterized microscopically by Mccormick (1966).
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