Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations

J Neurosurg. 2011 Dec;115(6):1169-74. doi: 10.3171/2011.7.JNS11536. Epub 2011 Aug 5.

Abstract

Object: Seizures are the most common presenting symptom of supratentorial cerebral cavernous malformations (CCMs) and progress to medically refractory epilepsy in 40% of patients. Predictors of seizure freedom in the resection of CCMs are incompletely understood.

Methods: The authors systematically reviewed the published literature on seizure freedom following the resection of supratentorial CCMs in patients presenting with seizures. Seizure outcomes were stratified across 12 potential prognostic variables. A total of 1226 patients with supratentorial CCMs causing seizures were identified across 31 predominantly retrospective studies; 361 patients had medically refractory epilepsy.

Results: Seventy-five percent of the patients were seizure free after microsurgical lesion removal, whereas 25% continued to have seizures. All patients had had preoperative seizures and > 6 months of postoperative follow-up. Modifiable predictors of postoperative seizure freedom included gross-total resection (OR 36.6, 95% CI 8.5-157.5) and surgery within 1 year of symptom onset (OR 1.83, 95% CI 1.30-2.58). Additional prognostic indicators of a favorable outcome were a CCM size < 1.5 cm (OR 15.4, 95% CI 5.2-45.4), the absence of multiple CCMs (OR 2.02, 95% CI 1.13-3.60), medically controlled seizures (OR 2.38, 95% CI 1.29-4.39), and the lack of secondarily generalized seizures (OR 3.33, 95% CI 2.09-5.30). Other factors, including extended resection of the hemosiderin ring, were not significantly predictive.

Conclusions: In the surgical treatment of supratentorial CCMs, gross-total resection and early operative intervention may improve seizure outcome. While surgery should not be considered the first-line treatment for CCM-related epilepsy, it is important to understand the variables associated with seizure freedom in CCM resection given the considerable morbidity and diminished quality of life associated with epilepsy.

Publication types

  • Meta-Analysis

MeSH terms

  • Adolescent
  • Adult
  • Epilepsy / diagnosis
  • Epilepsy / epidemiology*
  • Female
  • Hemangioma, Cavernous, Central Nervous System / epidemiology*
  • Hemangioma, Cavernous, Central Nervous System / surgery*
  • Humans
  • Male
  • Morbidity
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology*
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Young Adult