Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas.

BACKGROUND The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area. OBJECTIVE To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery. METHODS Multicenter international retrospective cohort analysis of adult patients benefitting from a functional-based surgical resection with intraoperative functional brain mapping for a supratentorial CA within or close to eloquent brain areas. RESULTS A total of 109 patients (66.1% women; mean age 38.4 ± 12.5 yr), were studied. Age >38 yr (odds ratio [OR], 7.33; 95% confidence interval [CI], 1.53-35.19; P = .013) and time to surgery > 12 mo (OR, 18.21; 95% CI, 1.11-296.55; P = .042) are independent predictors of uncontrolled seizures at the time of surgery. Focal deficit (OR, 10.25; 95% CI, 3.16-33.28; P < .001) is an independent predictor of inability to work at the time of surgery. History of epileptic seizures at the time of surgery (OR, 7.61; 95% CI, 1.67-85.42; P = .003) and partial resection of the CA and/or of the hemosiderin rim (OR, 12.02; 95% CI, 3.01-48.13; P < .001) are independent predictors of uncontrolled seizures postoperatively. Inability to work at the time of surgery (OR, 19.54; 95% CI, 1.90-425.48; P = .050), Karnofsky Performance Status ≤ 70 (OR, 51.20; 95% CI, 1.20-2175.37; P = .039), uncontrolled seizures postoperatively (OR, 105.33; 95% CI, 4.32-2566.27; P = .004), and worsening of cognitive functions postoperatively (OR, 13.71; 95% CI, 1.06-176.66; P = .045) are independent predictors of inability to work postoperatively. CONCLUSION The functional-based resection using intraoperative functional brain mapping allows safe resection of CA and the peripheral hemosiderin rim located within or close to eloquent brain areas.

[1]  Y. Mao,et al.  Long-Term Outcomes of Surgical Treatment in 181 Patients with Supratentorial Cerebral Cavernous Malformation-Associated Epilepsy. , 2017, World neurosurgery.

[2]  H. Duffau,et al.  Resection of cavernous angioma located in eloquent areas using functional cortical and subcortical mapping under awake conditions. Outcomes in a 50-case multicentre series. , 2017, Neuro-Chirurgie.

[3]  E. Dezamis,et al.  Direct electrical bipolar electrostimulation for functional cortical and subcortical cerebral mapping in awake craniotomy. Practical considerations. , 2017, Neuro-Chirurgie.

[4]  E. Dezamis,et al.  Functional and oncological outcomes following awake surgical resection using intraoperative cortico-subcortical functional mapping for supratentorial gliomas located in eloquent areas. , 2017, Neuro-Chirurgie.

[5]  H. Duffau,et al.  Network Plasticity and Intraoperative Mapping for Personalized Multimodal Management of Diffuse Low-Grade Gliomas , 2017, Front. Surg..

[6]  P. Schucht,et al.  Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis , 2017, Neurosurgical Review.

[7]  C. Schaller,et al.  Should we resect peri-lesional hemosiderin deposits when performing lesionectomy in patients with cavernoma-related epilepsy (CRE)? , 2016, Neurosurgical Review.

[8]  Hugues Duffau,et al.  Low Rate of Intraoperative Seizures During Awake Craniotomy in a Prospective Cohort with 374 Supratentorial Brain Lesions: Electrocorticography Is Not Mandatory. , 2015, World neurosurgery.

[9]  Gao Chen,et al.  The Role of Hemosiderin Excision in Seizure Outcome in Cerebral Cavernous Malformation Surgery: A Systematic Review and Meta-Analysis , 2015, PloS one.

[10]  Lingzhong Meng,et al.  Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. , 2015, Journal of neurosurgery.

[11]  A. Palmini,et al.  Cerebral cavernous malformations in the setting of focal epilepsies: pathological findings, clinical characteristics, and surgical treatment principles , 2014, Acta Neuropathologica.

[12]  Jiyao Jiang,et al.  Seizure outcome after surgical resection of supratentorial cavernous malformations plus hemosiderin rim in patients with short duration of epilepsy , 2014, Clinical Neurology and Neurosurgery.

[13]  H. Lüders,et al.  Cavernoma‐related epilepsy: Review and recommendations for management—Report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies , 2013, Epilepsia.

[14]  C. Elger,et al.  Surgical management and long‐term seizure outcome after epilepsy surgery for different types of epilepsy associated with cerebral cavernous malformations , 2013, Epilepsia.

[15]  H. Duffau,et al.  Awake mapping for resection of cavernous angioma and surrounding gliosis in the left dominant hemisphere: surgical technique and functional results: clinical article. , 2012, Journal of neurosurgery.

[16]  M. Berger,et al.  Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[17]  B. Meyer,et al.  Surgical treatment of symptomatic cerebral cavernous malformations in eloquent brain regions , 2012, Acta Neurochirurgica.

[18]  E. Chang,et al.  Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations. , 2011, Journal of neurosurgery.

[19]  Dong Wang,et al.  Intraoperative MRI with integrated functional neuronavigation-guided resection of supratentorial cavernous malformations in eloquent brain areas , 2011, Journal of Clinical Neuroscience.

[20]  R. Salman,et al.  Seizure risk from cavernous or arteriovenous malformations , 2011, Neurology.

[21]  Rodney A Gabriel,et al.  Supratentorial cavernous malformations in eloquent and deep locations: surgical approaches and outcomes. Clinical article. , 2011, Journal of neurosurgery.

[22]  Mitchel S. Berger,et al.  Operative techniques for gliomas and the value of extent of resection , 2009, Neurotherapeutics.

[23]  E. Chang,et al.  SEIZURE CHARACTERISTICS AND CONTROL AFTER MICROSURGICAL RESECTION OF SUPRATENTORIAL CEREBRAL CAVERNOUS MALFORMATIONS , 2009, Neurosurgery.

[24]  F. Rosenow,et al.  Transsulcal approach supported by navigation-guided neurophysiological monitoring for resection of paracentral cavernomas , 2009, Clinical Neurology and Neurosurgery.

[25]  Seung-Chyul Hong,et al.  Supratentorial cavernous angiomas presenting with seizures: Surgical outcomes in 60 consecutive patients , 2009, Seizure.

[26]  H. Deda,et al.  Critically Located Cavernous Malformations , 2007, Minimally invasive neurosurgery : MIN.

[27]  H. Stefan,et al.  Prediction of postoperative outcome with special respect to removal of hemosiderin fringe: A study in patients with cavernous haemangiomas associated with symptomatic epilepsy , 2007, Seizure.

[28]  C. Elger,et al.  Seizure Outcome after Resection of Supratentorial Cavernous Malformations: A Study of 168 Patients , 2007, Epilepsia.

[29]  F. Esposito,et al.  Clinical progression and familial occurrence of cerebral cavernous angiomas: the role of angiogenic and growth factors. , 2006, Neurosurgical focus.

[30]  F. Andermann,et al.  Seizure Outcome after Resection of Cavernous Malformations Is Better When Surrounding Hemosiderin‐stained Brain Also Is Removed , 2006, Epilepsia.

[31]  A. Siegel,et al.  Biological activity of paediatric cerebral cavernomas: an immunohistochemical study of 28 patients , 2006, Child's Nervous System.

[32]  A. Siegel,et al.  Biological activity of adult cavernous malformations: a study of 56 patients. , 2005, Journal of neurosurgery.

[33]  U. Ebeling,et al.  Seizure control following surgery in supratentorial cavernous malformations: a retrospective study in 77 patients , 2005, Acta Neurochirurgica.

[34]  H. Duffau,et al.  Successful resection of a left insular cavernous angioma using neuronavigation and intraoperative language mapping , 2005, Acta Neurochirurgica.

[35]  Dennis D Spencer,et al.  Physiology of Human Cortical Neurons Adjacent to Cavernous Malformations and Tumors , 2003, Epilepsia.

[36]  O Ganslandt,et al.  Image-guided removal of supratentorial cavernomas in critical brain areas: application of neuronavigation and intraoperative magnetic resonance imaging. , 2003, Minimally invasive neurosurgery : MIN.

[37]  S. Shorvon,et al.  Supratentorial cavernous haemangiomas and epilepsy: a review of the literature and case series , 1999, Journal of neurology, neurosurgery, and psychiatry.

[38]  K R Hess,et al.  Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. , 1998, Neurosurgery.

[39]  A. Hamberger,et al.  High Levels of Glycine and Serine as a Cause of the Seizure Symptoms of Cavernous Angiomas? , 1996, Journal of neurochemistry.

[40]  R. Goodman,et al.  Seizure outcome after lesionectomy for cavernous malformations. , 1995, Journal of neurosurgery.

[41]  I. Awad,et al.  Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms , 1994, Epilepsia.

[42]  John R. Robinson,et al.  Natural history of the cavernous angioma. , 1991, Journal of neurosurgery.

[43]  D. N. Pathak,et al.  Lipid Peroxidation and Glutathione Peroxidase, Glutathione Reductase, Superoxide Dismutase, Catalase, and Glucose‐6‐Phosphate Dehydrogenase Activities in FeCl3‐Induced Epileptogenic Foci in the Rat Brain , 1990, Epilepsia.

[44]  B. Rilliet,et al.  [131 cases of cavernous angioma (cavernomas) of the CNS, discovered by retrospective analysis of 24,535 autopsies]. , 1989, Neuro-Chirurgie.

[45]  R. Mattson,et al.  Selective memory improvement and impairment in temporal lobectomy for epilepsy , 1984, Annals of neurology.