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[Surgical treatment of cerebral vascular pathologies in epileptic patients]
A Rassi Neto1, P R Ribeiro, M A Prates
1Departamento de Neurologiae Neurocirurgia, Universidade Federal de Sáo Paulo-Escola Paulista de Medicina (UNIFESP-EPM), Brasil.
Insights
Surgery for brain vascular lesions like arteriovenous malformations (AVM) and cavernomas can significantly reduce or eliminate debilitating seizures in patients. This intervention offers hope for improved quality of life in difficult-to-control epilepsy cases.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Neurology
Context:
- Epilepsy surgery is increasingly indicated for difficult-to-control cases.
- Cerebral vascular lesions, including arteriovenous malformations (AVM) and cavernomas, are associated with epilepsy.
- Surgical intervention for these lesions has advanced with diagnostic and surgical techniques.
Purpose:
- To evaluate the efficacy of surgical resection for cerebral vascular lesions in patients with intractable epilepsy.
- To assess seizure reduction and freedom post-operatively.
Summary:
- Nine patients (12-42 years) with frequent seizures due to cerebral vascular lesions underwent surgical lesionectomy.
- Four patients also had resection of the irritative perilesional area identified by electrocorticography.
- Pathology revealed five cavernomas, three AVMs, and one venous angioma, located in the temporal, frontal, and parietal lobes.
Impact:
- All patients experienced a reduction in seizure frequency post-surgery.
- Seven out of nine patients achieved complete seizure freedom, indicating significant therapeutic benefit.
- Surgical management of these vascular lesions is a viable option for refractory epilepsy.
Abstract:
Surgery of arteriovenous malformations (AVM) and of cavernous angiomas (cavernoma) in the majority of cases is indicated subsequently to episodes of bleeding. With the development of techniques for diagnosis and surgery for epilepsy of difficult control, indication for surgery of these vascular lesions has become greater. We present nine patients with cerebral vascular lesions and very frequent crises in spite of adequate clinical treatment. Ages ranged from 12 to 42 years with an average of 25 years; there was a prevalence of the male sex (2:1). Surgery consisted of exercises of the lesion in all cases and in four there was also resection of the perilesional irritative area shown by electrocorticography. The pathologic study of lesions showed five cases of cavernoma, three cases of AVM, and one case of venous angioma. As to localization, we observed three lesions in the temporal lobe, four in the frontal, and two in the parietal region. Outpatient follow-up showed a reduction in crises in all of the patients, and seven evolved seizure free following surgery.