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Seizure outcome after lesionectomy for cavernous malformations
D S Cohen1, G P Zubay, R R Goodman
1Department of Neurological Surgery, Neurological Institute of New York, Columbia Presbyterian Medical Center, New York, USA.
Journal of Neurosurgery
|August 1, 1995
Summary
Surgical lesionectomy alone effectively treats seizures in most patients with cavernous malformations. However, longer seizure histories and higher seizure frequency predict poorer outcomes, suggesting a need for alternative surgical approaches in these cases.
Area of Science:
- Neurosurgery
- Epileptology
- Neurology
Background:
- Supratentorial cavernous malformations (SCMs) frequently cause seizures.
- Surgical resection (lesionectomy) is a common treatment for SCM-associated epilepsy.
- Predicting seizure outcomes after lesionectomy is crucial for surgical planning.
Purpose of the Study:
- To identify factors predicting seizure recurrence after lesionectomy for SCMs.
- To evaluate the efficacy of lesionectomy alone in eradicating seizures associated with SCMs.
Main Methods:
- Retrospective analysis of 51 patients with SCMs and preoperative seizures.
- Postoperative follow-up of at least 1 year.
- Analysis of preoperative seizure history duration and frequency, and patient sex as potential predictors of seizure outcome.
Main Results:
- 15 out of 50 patients (30%) experienced persistent postoperative seizures.
- Increased duration of preoperative seizure history (p=0.03), higher number of preoperative seizures (p<0.003), and female sex (p<0.04) were associated with continued seizures.
- Patients with seizure history <2 months or only one seizure had a 100% seizure-free rate post-lesionectomy.
Conclusions:
- Lesionectomy alone is highly effective for patients with short seizure histories and infrequent seizures.
- Patients with prolonged or frequent preoperative seizures may require more extensive surgical interventions beyond simple lesionectomy.
- Predictive factors identified can guide surgical strategy for SCM-associated epilepsy.