Magnetic resonance imaging of the so-called cerebral cryptic angiomas

Lesionectomy in epileptogenic temporal lobe lesions: preoperative seizure course and postoperative outcome

A series of 54 patients operated on for temporal epileptogenic lesions is reported: 36 had slow growing tumours, 18 supratentorial cavernous angiomas. The patients were divided into two different groups according to the presence of seizures controlled (group 1) or not controlled (group 2) by antiepileptic drugs (AEDs). All the patients underwent preoperative scalp EEG and magnetic resonance imaging (MRI). They were operated on by pure lesionectomy, associated with amygdalo-hippocampectomy in 8 cases of uncontrolled seizures. Postoperatively they underwent MRI examination which revealed an incomplete lesionectomy in 12 cases. Patients were followed up after surgery for at least 2 years, 6 of them were reoperated on for the persistence (or regrowth) of the tumour. The results of epilepsy outcome are reported. These cases underline the importance of preoperative electroclinical study, in order to determine the relationship between lesion location and epileptic focus. If good concordance is present, a complete lesionectomy is enough to cure the patient. In other cases associated amygdalo-hippocampectomy leads to better results, while more complicated cases may need preoperative stereo-EEG studies.

Supratentorial cavernous angiomas and epileptic seizures: preoperative course and postoperative outcome

OBJECTIVE

Patients operated on for supratentorial cavernous angiomas were studied to define the incidence and the course of seizures in their clinical history. Electroclinical and neuroradiological data were correlated with the location of cavernomas. The impact of lesionectomy on the outcome of seizures was evaluated.

METHODS

Preoperative clinical data on the history of the seizures, semeiology, incidence, severity, and response to antiepileptic drugs were analyzed. The location of the cavernomas, revealed by magnetic resonance imaging, was correlated with electroencephalographic and clinical data. Postoperative clinical and neuroradiological data were evaluated, with particular consideration to the outcome of the seizures, antiepileptic drug withdrawal, and the completeness of the lesion excision.

RESULTS

A higher incidence of severe epilepsy was observed in the patients with mesiotemporal and cortical angiomas. In most of the patients (78.7%), a good concordance between the site of the lesion and the electroclinical data was found. The complete removal of the lesion led to a favorable outcome, with discontinuation of antiepileptic drugs achieved in one-quarter of the patients.

CONCLUSION

A high percentage of patients with cortical cavernomas had epileptic seizures. They often presented with chronic intractable epilepsy (44.7% in our series). In cases of good concordance between the electroclinical data and the location of the angioma, complete lesionectomy led to the disappearance of seizures. Removal of the hemosiderin ring did not correlate with better outcome. Preoperative ictal scalp recordings to assess the topographic relationship between the cavernoma and the epileptic seizures could improve outcome, which suggests different surgical strategies (lesionectomy versus enlarged resection) in patients without a clear-cut concordance between the site of the lesion and the ictal semeiology.