Departments of1Neurosurgery and.
2Epileptology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
Neurosurg Focus. 2020 Apr 1;48(4):E6. doi: 10.3171/2020.1.FOCUS19920.
Cavernoma-related epilepsy (CRE) is a frequent symptom in patients with cerebral cavernous malformations (CCMs). Reports on surgical management and seizure outcome of epileptogenic CCM often focus on intracranial cavernoma in general. Therefore, data on CCMs within the temporal lobe are scarce. The authors therefore analyzed their institutional data.
From 2003 to 2018, 52 patients suffering from CCMs located within the temporal lobe underwent surgery for CRE at University Hospital Bonn. Information on patient characteristics, preoperative seizure history, preoperative evaluation, surgical strategies, postoperative complications, and seizure outcome was assessed and further analyzed. Seizure outcome was assessed 12 months after surgery according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class I) versus unfavorable (ILAE classes II-VI).
Overall, 47 (90%) of 52 patients with CCMs located in the temporal lobe and CRE achieved favorable seizure outcome. Pure lesionectomy was performed in 5 patients, extended lesionectomy with resection of the hemosiderin rim in 38 patients, and anterior temporal lobectomy in 9 patients with temporal lobe CCM. Specifically, 36 patients (69%) suffered from drug-resistant epilepsy (DRE), 3 patients (6%) from chronic CRE, and 13 patients (25%) sustained sporadic CRE. In patients with DRE, favorable seizure outcome was achieved in 32 (89%) of 36 patients. Patients with DRE were significantly older than patients with CCM-associated chronic or sporadic seizures (p = 0.02). Furthermore, patients with DRE more often underwent additional amygdalohippocampectomy following the recommendation of presurgical epileptological evaluation.
Favorable seizure outcome is achievable in a substantial number of patients with epileptogenic CCM located in the temporal lobe, even if patients suffered from drug-resistant CRE. For adequate counseling and monitoring, patients with CRE should undergo a thorough pre- and postsurgical evaluation in dedicated epilepsy surgery programs.
海绵状血管畸形（CM）相关癫痫（CRE）是脑 CM 患者的常见症状。关于致痫性 CM 的手术管理和癫痫发作结果的报告通常通常侧重于颅内 CM 一般情况。因此，关于颞叶内 CM 的数据很少。作者因此分析了他们的机构数据。
2003 年至 2018 年，52 例位于颞叶内的 CM 患者因 CRE 在波恩大学医院接受手术。评估了患者特征、术前癫痫发作史、术前评估、手术策略、术后并发症和癫痫发作结果，并进一步分析。根据国际抗癫痫联盟（ILAE）分类，术后 12 个月评估癫痫发作结果，并分为有利（ILAE 1 级）与不利（ILAE 2-VI 级）。
总体而言，52 例位于颞叶内的 CM 患者中有 47 例（90%）癫痫发作结果有利。5 例患者行单纯病灶切除术，38 例患者行含铁血黄素环切除术的扩展病灶切除术，9 例患者行颞叶 CM 前颞叶切除术。具体而言，36 例（69%）患者患有耐药性癫痫（DRE），3 例（6%）患者患有慢性 CRE，13 例（25%）患者患有散发性 CRE。在 DRE 患者中，36 例（89%）患者的癫痫发作结果有利。DRE 患者明显比 CM 相关慢性或散发性癫痫发作患者年龄大（p=0.02）。此外，DRE 患者更常根据术前癫痫评估的建议进行额外的杏仁核海马切除术。
即使患者患有耐药性 CRE，位于颞叶内的致痫性 CM 患者仍能获得良好的癫痫发作结果。为了进行充分的咨询和监测，CRE 患者应在专门的癫痫外科手术项目中进行全面的术前和术后评估。
