Temporal lobe epilepsy and cavernous malformations: surgical strategies and long-term outcomes

被引:15
|
作者
Vale, Fernando L. [1 ]
Vivas, Andrew C. [1 ]
Manwaring, Jotham [1 ]
Schoenberg, Mike R. [2 ]
Benbadis, Selim R. [3 ]
机构
[1] Univ S Florida, Dept Neurosurg & Brain Repair, Morsani Coll Med, Tampa, FL 33620 USA
[2] Univ S Florida, Morsani Coll Med, Dept Psychiat & Behav Neurosci, Tampa, FL USA
[3] Univ S Florida, Dept Neurol, Morsani Coll Med, Tampa, FL 33620 USA
关键词
Epilepsy; Cavernous malformation; Temporal lobe; Pathology; QUALITY-OF-LIFE; INTRACTABLE EPILEPSY; REFRACTORY EPILEPSY; SEIZURE OUTCOMES; NATURAL-HISTORY; GYRUS APPROACH; BRAIN-TUMORS; RESECTION; LOBECTOMY; SURGERY;
D O I
10.1007/s00701-015-2592-4
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Cerebral cavernous malformations (CCM) of the temporal lobe often present with seizures. Surgical resection of these lesions can offer durable seizure control. There is, however, no universally accepted methodology for assessing and surgically treating these patients. We propose an algorithm to maximize positive surgical outcomes (seizure control) while minimizing post-surgical neurological deficit. A retrospective review of 34 patients who underwent epilepsy surgery for radiographically proven temporal lobe CCM was conducted. Patients underwent a relatively standard work-up for seizure localization. In patients with mesial temporal lobe epilepsy (MTLE), a complete resection of the epileptogenic zone was performed including amygdalo-hippocampectomy in addition to a lesionectomy if not contraindicated by pre-operative work-up. Patients with neocortical epilepsy underwent intraoperative electrocorticography (ECoG)-guided lesionectomy. Seizure-free rate for mesial and neocortical (anterior, lateral, and basal) location was 90 vs. 83 %, respectively. Complete resection of the lesion, irrespective of location, was statistically significant for seizure control (p = 0.018). There was no difference in seizure control based on disease duration or location (p > 0.05). Patients with mesial temporal CCM who presented with MTLE were presumed to also have mesial temporal sclerosis (MTS), or dual pathology. These patients underwent routine resection of the mesial structures. Interestingly, patients who had MTLE and basal (neocortical) lesions who underwent a mesial resection for suspected MTS were found not to have dual pathology. Patients with temporal lobe CCM should be offered resection for durable seizure control, prevention of secondary epileptogenic foci, and elimination of hemorrhage risk. The preoperative work-up should follow a team approach. Surgical intervention should include complete lesionectomy in all cases. Intra or extra-operative ECoG for neocortical lesions may be beneficial. Management of mesial temporal CCMs (archicortex) should consider resection of a well-defined epileptogenic zone (including mesial structures) due to high probability of pathologically proven MTS. The use of this treatment algorithm is useful for the education and treatment of these patients.
引用
收藏
页码:1887 / 1895
页数:9
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