Download PDF
J Neurol Surg A Cent Eur Neurosurg 2021; 82(01): 059-063
DOI: 10.1055/s-0040-1715496
Original Article

Risk Factors for Poor Postoperative Outcome and Epileptic Symptoms in Patients Diagnosed with Cerebral Cavernous Malformations

Fabian Winter
1   Department of Neurosurgery, Medical University of Vienna, Wien, Austria
,
Lisa Blair
2   Department of Neurosurgery, Erlangen University Hospital, Erlangen, Bayern, Germany
,
Michael Buchfelder
2   Department of Neurosurgery, Erlangen University Hospital, Erlangen, Bayern, Germany
,
Karl Roessler
1   Department of Neurosurgery, Medical University of Vienna, Wien, Austria
2   Department of Neurosurgery, Erlangen University Hospital, Erlangen, Bayern, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background and Study Objective Roughly 12 to 47% of individuals with cerebral cavernous malformations (CCM) are asymptomatic, while other people may present with symptoms such as epileptic seizures, neurologic deficits, and intracerebral hemorrhages (IH). The aim of this study was to report our experience of postoperative outcomes of patients diagnosed with CCMs.

Patients and Methods We present a series of consecutive patients who underwent surgical treatment for a diagnosed CCM between January 2003 and March 2014. Data were retrospectively analyzed with respect to preoperative visits, operating reports, patient admission charts, and postoperative follow-up visits. The Engel scale was used to evaluate the outcome of patients with epileptic seizures.

Results A total of 91 patients were included with a mean age of 38.8 ± 15 years (range: 2–72 years). Prior to surgery, 57 of these patients had epileptic seizures, while 25 patients recorded at least one episode of IH with a latency time of 6.7 ± 8.5 years (range: 3–240 months) in between hemorrhages. A CCM located within the brainstem was significantly associated with IH prior to surgery (p = 0.000). If the CCM was adjacent to an eloquent brain area, the postoperative outcome in terms of seizure control was significantly worse (p = 0.033). In addition, a trend for worsened outcomes according to the Engel scale was observed in patients with more than one seizure prior to surgery (p = 0.055).

Conclusion Proximity of CCMs to eloquent brain areas is a risk factor for poor postoperative outcome with respect to a lower rate of medication reduction as well as a lower rate of epileptic seizure omission. This underlines the importance of patient-specific therapeutic approaches.

Keywords

cerebral cavernous malformation - cavernoma - outcome - epileptic symptoms


Publication History

Received: 08 September 2019

Accepted: 12 March 2020

Article published online:
05 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Robinson JR, Awad IA, Little JR. Natural history of the cavernous angioma. J Neurosurg 1991; 75 (05) 709-714
    CrossrefPubMedGoogle Scholar
  • 2 Porter PJ, Willinsky RA, Harper W, Wallace MC. Cerebral cavernous malformations: natural history and prognosis after clinical deterioration with or without hemorrhage. J Neurosurg 1997; 87 (02) 190-197
    CrossrefPubMedGoogle Scholar
  • 3 Aiba T, Tanaka R, Koike T, Kameyama S, Takeda N, Komata T. Natural history of intracranial cavernous malformations. J Neurosurg 1995; 83 (01) 56-59
    CrossrefPubMedGoogle Scholar
  • 4 Casazza M, Broggi G, Franzini A. et al. Supratentorial cavernous angiomas and epileptic seizures: preoperative course and postoperative outcome. Neurosurgery 1996; 39 (01) 26-32 , discussion 32–34
    CrossrefPubMedGoogle Scholar
  • 5 Al-Shahi Salman R, Hall JM, Horne MA. et al; Scottish Audit of Intracranial Vascular Malformations (SAIVMs) collaborators. Untreated clinical course of cerebral cavernous malformations: a prospective, population-based cohort study. Lancet Neurol 2012; 11 (03) 217-224
    CrossrefPubMedGoogle Scholar
  • 6 Bernotas G, Rastenytė D, Deltuva V, Matukevičius A, Jaškevičienė V, Tamašauskas A. Cavernous angiomas: an uncontrolled clinical study of 87 surgically treated patients. Medicina (Kaunas) 2009; 45 (01) 21-28
    CrossrefPubMedGoogle Scholar
  • 7 Clatterbuck RE, Moriarity JL, Elmaci I, Lee RR, Breiter SN, Rigamonti D. Dynamic nature of cavernous malformations: a prospective magnetic resonance imaging study with volumetric analysis. J Neurosurg 2000; 93 (06) 981-986
    CrossrefPubMedGoogle Scholar
  • 8 Wostrack M, Shiban E, Harmening K. et al. Surgical treatment of symptomatic cerebral cavernous malformations in eloquent brain regions. Acta Neurochir (Wien) 2012; 154 (08) 1419-1430
    CrossrefPubMedGoogle Scholar
  • 9 Wieser HG, Blume WT, Fish D. et al. Wieser Wg 2001; 42 (02) 282-286
    PubMed
  • 10 Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986; 65 (04) 476-483
    CrossrefPubMedGoogle Scholar
  • 11 Porter RW, Detwiler PW, Spetzler RF. et al. Cavernous malformations of the brainstem: experience with 100 patients. J Neurosurg 1999; 90 (01) 50-58
    CrossrefPubMedGoogle Scholar
  • 12 Stefan H, Walter J, Kerling F, Blümcke I, Buchfelder M. Supratentorial cavernoma and epileptic seizures. Are there predictors for postoperative seizure control?. Nervenarzt 2004; 75 (08) 755-762
    PubMedGoogle Scholar
  • 13 Ferroli P, Casazza M, Marras C, Mendola C, Franzini A, Broggi G. Cerebral cavernomas and seizures: a retrospective study on 163 patients who underwent pure lesionectomy. Neurol Sci 2006; 26 (06) 390-394
    CrossrefPubMedGoogle Scholar
  • 14 Baumann CR, Acciarri N, Bertalanffy H. et al. Seizure outcome after resection of supratentorial cavernous malformations: a study of 168 patients. Epilepsia 2007; 48 (03) 559-563
    CrossrefPubMedGoogle Scholar
  • 15 Moran NF, Fish DR, Kitchen N, Shorvon S, Kendall BE, Stevens JM. Supratentorial cavernous haemangiomas and epilepsy: a review of the literature and case series. J Neurol Neurosurg Psychiatry 1999; 66 (05) 561-568
    CrossrefPubMedGoogle Scholar
  • 16 Englot DJ, Han SJ, Lawton MT, Chang EF. Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations. J Neurosurg 2011; 115 (06) 1169-1174
    CrossrefPubMedGoogle Scholar
  • 17 Hammen T, Romstöck J, Dörfler A, Kerling F, Buchfelder M, Stefan H. Prediction of postoperative outcome with special respect to removal of hemosiderin fringe: a study in patients with cavernous haemangiomas associated with symptomatic epilepsy. Seizure 2007; 16 (03) 248-253
    CrossrefPubMedGoogle Scholar
  • 18 Kim W, Stramotas S, Choy W, Dye J, Nagasawa D, Yang I. Prognostic factors for post-operative seizure outcomes after cavernous malformation treatment. J Clin Neurosci 2011; 18 (07) 877-880
    CrossrefPubMedGoogle Scholar
  • 19 Gralla J, Ganslandt O, Kober H, Buchfelder M, Fahlbusch R, Nimsky C. Image-guided removal of supratentorial cavernomas in critical brain areas: application of neuronavigation and intraoperative magnetic resonance imaging. Minim Invasive Neurosurg 2003; 46 (02) 72-77
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Folkersma H, Mooij JJA. Follow-up of 13 patients with surgical treatment of cerebral cavernous malformations: effect on epilepsy and patient disability. Clin Neurol Neurosurg 2001; 103 (02) 67-71
    CrossrefPubMedGoogle Scholar
  • 21 Zhao J, Wang Y, Kang S. et al. The benefit of neuronavigation for the treatment of patients with intracerebral cavernous malformations. Neurosurg Rev 2007; 30 (04) 313-318 , discussion 319
    CrossrefPubMedGoogle Scholar
  • 22 Rosenow F, Alonso-Vanegas MA, Baumgartner C. et al; Surgical Task Force, Commission on Therapeutic Strategies of the ILAE. Cavernoma-related epilepsy: review and recommendations for management: report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2013; 54 (12) 2025-2035
    CrossrefPubMedGoogle Scholar
  • 23 Noto S, Fujii M, Akimura T. et al. Management of patients with cavernous angiomas presenting epileptic seizures. Surg Neurol 2005; 64 (06) 495-498 , discussion 498–499
    CrossrefPubMedGoogle Scholar
  • 24 Tarnaris A, Fernandes RP, Kitchen ND. Does conservative management for brain stem cavernomas have better long-term outcome?. Br J Neurosurg 2008; 22 (06) 748-757
    CrossrefPubMedGoogle Scholar
  • 25 Li D, Yang Y, Hao SY. et al. Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations. J Neurosurg 2013; 119 (04) 996-1008
    CrossrefPubMedGoogle Scholar
  • 26 Li H, Ju Y, Cai BW, Chen J, You C, Hui XH. Experience of microsurgical treatment of brainstem cavernomas: report of 37 cases. Neurol India 2009; 57 (03) 269-273
    CrossrefPubMedGoogle Scholar
  • 27 Bruneau M, Bijlenga P, Reverdin A. et al. Early surgery for brainstem cavernomas. Acta Neurochir (Wien) 2006; 148 (04) 405-414
    CrossrefPubMedGoogle Scholar
  • 28 Schwartz C, Grillhösl A, Schichor C. et al. Symptomatic cavernous malformations of the brainstem: functional outcome after microsurgical resection. J Neurol 2013; 260 (11) 2815-2822
    CrossrefPubMedGoogle Scholar
  • 29 Chen L, Zhao Y, Zhou L, Zhu W, Pan Z, Mao Y. Surgical strategies in treating brainstem cavernous malformations. Neurosurgery 2011; 68 (03) 609-620 , discussion 620–621
    CrossrefPubMedGoogle Scholar
  • 30 Bradac O, Majovsky M, de Lacy P, Benes V. Surgery of brainstem cavernous malformations. Acta Neurochir (Wien) 2013; 155 (11) 2079-2083
    CrossrefPubMedGoogle Scholar
  • 31 Maraire JN, Awad IA. Intracranial cavernous malformations: lesion behavior and management strategies. Neurosurgery 1995; 37 (04) 591-605
    CrossrefPubMedGoogle Scholar
  • 32 Dukatz T, Sarnthein J, Sitter H. et al. Quality of life after brainstem cavernoma surgery in 71 patients. Neurosurgery 2011; 69 (03) 689-695
    CrossrefPubMedGoogle Scholar
  • 33 Barker II FG, Amin-Hanjani S, Butler WE. et al; F.G. BII. Temporal clustering of hemorrhages from untreated cavernous malformations of the central nervous system. Neurosurgery 2001; 49 (01) 15-24 , discussion 24–25
    PubMedGoogle Scholar
  • 34 Samii M, Eghbal R, Carvalho GA, Mathies C. Surgical management of brainstem cavernous angioma. J Neurosurg 2001; 95 (05) 825-832
    CrossrefPubMedGoogle Scholar
  • 35 Gross BA, Batjer HH, Awad IA, Bendok BR, Du R. Brainstem cavernous malformations: 1390 surgical cases from the literature. World Neurosurg 2013; 80 (1–2): 89-93
    CrossrefPubMedGoogle Scholar
  • 36 Sommer B, Kasper BS, Coras R. et al. Surgical management of epilepsy due to cerebral cavernomas using neuronavigation and intraoperative MR imaging. Neurol Res 2013; 35 (10) 1076-1083
    CrossrefPubMedGoogle Scholar
  • 37 Wang X, Tao Z, You C, Li Q, Liu Y. Extended resection of hemosiderin fringe is better for seizure outcome: a study in patients with cavernous malformation associated with refractory epilepsy. Neurol India 2013; 61 (03) 288-292
    CrossrefPubMedGoogle Scholar
  • 38 Van Gompel JJ, Rubio J, Cascino GD, Worrell GA, Meyer FB. Electrocorticography-guided resection of temporal cavernoma: is electrocorticography warranted and does it alter the surgical approach?. J Neurosurg 2009; 110 (06) 1179-1185
    CrossrefPubMedGoogle Scholar