Cavernoma-Associated Epilepsy Within the Mesial Temporal Lobe: Surgical Management and Seizure Outcome

Kangmin He; M H S Alriashy; Zhen Fan; Nidan Qiao; Yujun Liao; Qingzhu An; Bin Xu; Jianping Song; Xin Zhang; Wei Zhu; Liang Chen; Ying Mao

doi:10.1016/j.wneu.2022.01.045

Cavernoma-Associated Epilepsy Within the Mesial Temporal Lobe: Surgical Management and Seizure Outcome

World Neurosurg. 2022 Apr:160:e464-e470. doi: 10.1016/j.wneu.2022.01.045. Epub 2022 Jan 18.

Authors

Kangmin He¹, M H S Alriashy¹, Zhen Fan¹, Nidan Qiao¹, Yujun Liao¹, Qingzhu An¹, Bin Xu¹, Jianping Song¹, Xin Zhang¹, Wei Zhu¹, Liang Chen², Ying Mao¹

Affiliations

¹ Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.
² Department of Neurosurgery, Fudan University Huashan Hospital, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China. Electronic address: chenlianghs@126.com.

PMID: 35051640
DOI: 10.1016/j.wneu.2022.01.045

Abstract

Objective: We sought to explore a treatment protocol for patients with mesial temporal cerebral cavernoma (MTC)-associated epilepsy.

Methods: All MTC-associated epilepsy patients admitted to our center between January 2005 and December 2013 were analyzed. Seizure outcome for each presurgical epilepsy type was reported. The modified Engel classification was used to assess outcome. The neurologic outcome was scored by the modified Rankin Scale.

Results: Fifty-three patients admitted to the center were seen by a functional electrocortigraphy (ECoG group) or vascular (non-ECoG group) neurosurgery team. There were 21 patients with drug-resistant epilepsy (DRE), 20 patients with chronic epilepsy (CE), and 12 patients with sporadic epilepsy (SE). The neurovascular team treated 37 (69.8%) patients, and the ECoG group treated 16 (30.2%) patients. All patients underwent a mean follow-up of 106.5 ± 29.1 months. Almost all SE patients (11/12, 91.7%) in both teams achieved seizure-free status at follow-up. In the CE group, the long-term seizure-free probability among patients in the ECoG and non-ECoG groups was (66.7%) and (52.9%), respectively. DRE patients in the ECoG group had a lower seizure relapse rate after surgery than those who underwent non-ECoG surgery (P = 0.042). Fifty-two patients (98.1%) complained of postsurgery memory loss. Seizure outcome in the first postoperative year was a reasonable predictor of long-term outcome.

Conclusions: A comprehensive preoperative and intraoperative assessment could help the patient with MTC-associated epilepsy choose a suitable surgical time and maximize the benefit between seizure control and cognition protection. The characters of intraoperative ECoG and postoperative seizure outcome at 1-year follow-up can predict a long-term epilepsy prognosis.

Keywords: Electrocorticography; Epilepsy; Mesial temporal cavernoma; Neuropsychological score.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Electrocorticography / methods
Electroencephalography
Epilepsy* / complications
Epilepsy* / surgery
Epilepsy, Temporal Lobe*
Humans
Neoplasm Recurrence, Local / complications
Seizures / complications
Seizures / surgery
Temporal Lobe / diagnostic imaging
Temporal Lobe / surgery
Treatment Outcome