Acta Neurochirurgica

, Volume 157, Issue 11, pp 1887–1895 | Cite as

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

  • Fernando L. Vale
  • Andrew C. Vivas
  • Jotham Manwaring
  • Mike R. Schoenberg
  • Selim R. Benbadis
Clinical Article - Functional
First Online:
Received:
Accepted:

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Epilepsy Cavernous malformation Temporal lobe Pathology 

Abbreviations

MTLE

Mesial temporal lobe epilepsy

MTS

Mesial temporal sclerosis

ECoG

Electrocorticography

MRI

Magnetic resonance imaging

CCM

Cerebral cavernous malformations

EC

Engel classification

EEG

Electroencephalography

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Notes

Acknowledgments

The authors thank Jason Liounakos, B.S., for his help with data collection, Katie Eichsteadt, MA, for the statistical analysis, and Mark Greenberg, M.D., for his art work.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Financial support

None.

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Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Fernando L. Vale
    • 1
  • Andrew C. Vivas
    • 1
  • Jotham Manwaring
    • 1
  • Mike R. Schoenberg
    • 2
  • Selim R. Benbadis
    • 3
  1. 1.Department of Neurosurgery & Brain RepairMorsani College of Medicine, University of South FloridaTampaUSA
  2. 2.Department of Psychiatry and Behavioral NeurosciencesUniversity of South Florida Morsani College of MedicineTampaUSA
  3. 3.Department of NeurologyMorsani College of Medicine, University of South FloridaTampaUSA

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