Cavernous angiomas in chronic epilepsy associated with focal cortical dysplasia

Both cavernous angiomas and focal cortical dysplasia (FCD) are well recognized causes of pharmacoresistant epilepsy. Anecdotal cases of FCD adjacent to cavernous angiomas have been documented in the literature. This study systematically reviews a series of cavernous angiomas in epilepsy patients, looking for evidence of coexistent FCD. 146 patients were diagnosed with cavernous angiomas on resection specimens from January 1989 to May 2011; 18 cases also had epilepsy and had ample tissue excised to assess for FCD. FCD was classified according to criteria outlined by Palmini et al. [12]. Patients included 10 females (55.6%); the mean age of study patients was 38.5 years (range 21 - 51 years) at the time of resection. All patients had a history of epilepsy (median 11 years) prior to surgery. 17 cavernomas were located in the temporal lobe and 1 in the occipital lobe. Adjacent FCD was identified in 13 out of the 18 cases (72.2%): Type Ia (n = 8; 61.5%), Type Ib (n = 4; 30.8%), and Type IIa (n = 1; 7.7%). After resection, a majority of the patients experienced resolution of their epilepsy (n = 14; 77.8%). Of the 4 patients that did not experience seizure resolution, 2 had evidence of adjacent FCD (Type Ia = 1, Type Ib = 1) and 2 did not. FCD is frequently present in association with cavernous angiomas in patients with chronic epilepsy. The type of FCD seen adjacent to these lesions varies, but most are Palmini et al. Type I. Resection of the cavernous angiomas and adjacent FCD often results in a resolution of the epilepsy.