[Surgery with neuronavigated mapping of cerebral cavernoma evoking epileptic seizures]

Cavernous hemangioma is increasingly recognized as the cause of epilepsy attributed to vasogenic foci. The clinical picture of this lesion is notable for epileptic seizures and intracerebral hemorrhage. Surgical excision of cavernoma remains the most effective antiepileptic modality. Good results of surgery are achieved with the use of modern operative procedures such as stereotaxy and neuronavigation.

Twelve patients with cavernous hemangioma were operated at the Department of Neurosurgery and Pediatric Neurosurgery, Pomeranian Medical University, Szczecin, between 1999 and 2008. This group included 10 females aged 7-54 years (mean 24.8 years) and 2 males aged 14-49 years (mean 31.5 years), 7 children (58.3%) and 5 adults (41.7%). Seven patients (58.3%) presented with generalized and the remaining 5 patients (41.7%) with secondarily generalized seizures. The mean time from onset of seizures to surgery was 2.6 months. All patients were operated using preoperative neuronavigated mapping to determine the optimal access to the lesion followed by neuronavigation-guided cavernoma excision. Postoperative neurological status was assessed with GOS scale and antiepileptic treatment outcome with Engel's scale as modified by Moran.

The caveroma was completely removed in each case. Postoperative follow-up time was 2-59 months (mean 30.3 months). Neurological status of all patients was category 5 of the GOS scale. Engel's class I outcome was achieved in all patients. Nine patients (75%) were weaned off antiepileptic drugs following normalization of EEG.

The following conclusions were drawn basing on the findings of this study: (1) Neuronavigation offers high precision and low traumatization which reduce the risk of neurological sequellae (neurological deficits and epilepsy) in patients operated for cavernoma; (2) Early resection of cavernoma offers the chance of curing epilepsy.