Cavernoma-Related Epilepsy: Postoperative Epilepsy Outcome and Analysis of the Predictive Factors, Case Series

BACKGROUND: Epilepsy is common in patients harboring cavernous malformation, and surgery is reported to be an effective treatment. However, few patients still experience seizures after surgery. We analyzed the outcome and predictive factors after cavernoma-related epilepsy (CRE) surgery.METHODS: A database was created for all patients with CRE treated surgically from 2003 to 2020 at a university hospital. A chart review, perioperative epilepsy workup, surgical strategies, and postoperative and follow-up notes were analyzed. Postoperative seizure outcome was eval-uated according to the Engel classification.RESULTS: Thirty-seven patients (40.5% women; mean age 39.1 +/- 14.5 years) were studied. The mean follow-up time was 5.6 +/- 3.9 years. Among 37 patients, 32 (86.5%) achieved Engel class I at the last follow-up. Engel class II was found in 1 (2.7%), Engel class III in 1 (2.7%), and Engel class IV in 3 (8.1%) cases. Engel class Ia was observed in 23 patients (62.2%). None of the patients had a worse seizure outcome after the operation (Engel class IVc). Univariate and multivariate analysis showed that short -standing, sporadic, or low-frequent (3) pound seizures were the only variables significantly associated with seizure freedom, whereas longstanding, drug-resistant, or high-frequent seizure history were associated with worse seizure outcomes.CONCLUSIONS: Surgical treatment results in favorable seizure control in most patients after CRE surgery. Long duration of epilepsy before surgery, high seizure frequency, and drug-resistant epilepsy could have a negative effect on seizure outcome (Engel class II -IV). Therefore, early sur-gical resection of the cavernoma after careful presurgical planning is recommended to achieve an optimal result.

Automated summary

This study analyzed the outcome and predictive factors after surgery for cavernoma-related epilepsy (CRE). The results showed that surgical treatment resulted in favorable seizure control in the majority of patients, although factors such as long duration of epilepsy before surgery, high seizure frequency, and drug-resistant epilepsy were associated with worse seizure outcomes. Early surgical resection of the cavernoma after careful presurgical planning is recommended to achieve optimal results.