Extended resection of hemosiderin fringe is better for seizure outcome: a study in patients with cavernous malformation associated with refractory epilepsy.

Abstract

BACKGROUND:

Cerebral cavernous malformation (CCM) is frequently associated with intractable focal epilepsy. Epileptogenicity is usually attributed to the hemosiderin deposits. Extent of resection is a crucial issue for achieving good seizure outcome.

AIM:

To assess whether seizure outcome is related to the extended resection (ER) of surrounding hemosiderin fringe brain tissue.

MATERIALS AND METHODS:

Between April 2000 and April 2008, 132 patients with CCM and refractory epilepsy were scheduled for surgery based on the high-resolution magnetic resonance imaging (MRI) findings and intensive video-electroencephalogram (EEG) monitoring. All patients underwent pre- and post-operative MRI. Based on MRI findings patients were grouped into: ER group (ER, hemosiderin completely removed) and lesionectomy group (LE, hemosiderin not/partially removed). Post-operative seizure outcome was compared between the two groups based on Engel and the International League Against Epilepsy outcome scales.

RESULTS:

At 1-year follow-up of the 86 patients in the ER group, 54 (74.4%) achieved seizure free outcome and in the LE group of the 46 patients, 20 (59.5%) achieved seizure-free outcome. At 5-year follow-up, 59.5% (25/42) of patients in ER group and 27.8% (5/18) of patients in LE group achieved seizure-free outcome. ER was not associated with increased neurological morbidity.

CONCLUSIONS:

Our study suggests that complete removal of hemosiderin fringe brain tissue surrounding CCMs may improve short-term and long-term seizure outcome.

• Authors: Xiaoyu Wang, Zhang Tao, Chao You, Qiang Li, Yi Liu
• Journal: Neurology India (Neurol India) 2013 May-Jun Vol. 61 Issue 3 Pg. 288-92 ISSN: 0028-3886 [Print] India
• PMID: 23860150 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Hemosiderin

Topics

• Adolescent
• Adult
• Aged
• Child
• Electroencephalography
• Female
• Follow-Up Studies
• Hemangioma, Cavernous, Central Nervous System (complications, surgery)
• Hemosiderin
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neurosurgical Procedures (methods)
• Seizures (etiology, surgery)
• Severity of Illness Index
• Treatment Outcome
• Young Adult