[Surgical treatment of patients with supratentorial cavernomas manifested with seizures]

Supratentorial compartment is the most frequent cavernomas location associated with seizures in 50-79% cases. Surgical removal of some cavernomas remains a delicate decision. To assess long-term epilepsy results in consecutive series of patients treated for supratentorial cavernomas.

Single-center retrospective study of 302 patients (2002-2010) with operated supratentorial cavernomas was performed. Male: female ratio= 139:163, age ranged 1 to 68 years, mean: 26.4. Multiple lesion were diagnosed in 27 (8.9%) patients, eloquent in 77 (24.9%) cases. Mean follow up was 55.2 months. Functional outcomes using modified Rankin scale and epilepsy outcomes using Engel scale were assessed. Data were statistically analyzed in respect to natural history, lesion type, location, size, extent of resection, use of anti-epileptic drugs, etc. Seizures suffered 74.8% of patients, generalized seizures--79.6% from those who have an epilepsy. In 34.5% of patients epileptic symptoms tended to worsen over time. Seizures improved in 78.2% patients post op, 62.3%--became seizure-free. Early surgery and less than 5 seizures in history were found a reliable predictors of better epilepsy outcome. Drug-resistant subgroup was associated with worse outcomes. Resection of gliosis and tailored ECoG-guided resection with respect to epilepsy outcome were not proved beneficial. Long-term disability was 9%, 3% in non-eloquent and 21% in eloquent and deep cavernomas group. One patient died (0.3%). Surgery remains an effective treatment for recurrent hemorrhage prevention and seizure control with acceptable morbidity. The benefits of surgery for eloquent and deep-seated cavernomas must be accurately weighted with higher risks. For symptomatic non-eloquent cavernomas surgical excision should be considered as soon as possible after disease onset.