Surgical treatment for the cavernous angioma in the temporal lobe secondary to epilepsy_Journal of Epilepsy

Authors：

 WANG Huanming , HU Fei , CHEN Jun , XIONG Yubo , YANG Congyang , CHEN Yang , TU Shengxu

Department of Neurosurgery, Wuhan Brain Hospital & Changhang General Hospital, Wuhan 430010, China;

Corresponding author：

WANG Huanming, Email: 1808381741@qq.com

Keywords：

Cavernous angioma; Temporal lobe; Epilepsy; Operation

DOI：

10.7507/2096-0247.20200036

Video：

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Objective To explore the clinical features and surgical treatment effects of cavernous angioma in the temporal lobe secondary to epilepsy.Method 38 cases of patients with cavernous angioma in the temporal lobe secondary to epilepsy were collected in Department of Neurosurgery of Wuhan Brain Hospital from Jan. 2010 to Jan. 2019. There were 17 males and 21 females, their age range from 8 to 57 years, average (40.05±14.64) years. Their illness duration ranged from 1 to 10 years, average (1.25±2.19) years. The clinical manifestations showed complex partial seizure in 7 cases, partial-secondary-generalized seizure in 8 cases, and generalized tonic-clonic seizure in 23 cases. All the patients underwent CT/MRI and long-term VEEG monitoring examination. Based on their results of clinical manifestations, combined with CT/MRI and VEEG results, all the patients underwent microsurgical cavernous angioma resection under the guidance of ECoG. If necessary, anterior temporal lobectomy or coortical coagulation should be added. The surgical effect were evaluated by Engel levels by followed up.Results The postoperative pathology confirmed the diagnosis of cavernous angioma. The follow-up of 1 ~ 9 years showed the seizure disappeared in 36 cases, and bad effect in 2 cases. The total surgical effect rate was 94.74% (36/38).Conclusions To the patients of cavernous angioma in the temporal lobe secondary to epilepsy, the glial scar and hemosiderin sedimentary zone should be resected after resecting the lesion, and if necessary, anterior temporal lobectomy or cortical coagulation could be added. If it is difficult to locate the lesion, neuronavigation and ultrasound can be used, and the postoperative curative result is satisfactory.

Citation： WANG Huanming, HU Fei, CHEN Jun, XIONG Yubo, YANG Congyang, CHEN Yang, TU Shengxu. Surgical treatment for the cavernous angioma in the temporal lobe secondary to epilepsy. Journal of Epilepsy, 2020, 6(3): 205-209. doi: 10.7507/2096-0247.20200036 Copy

1.	Williamson A, Patrylo PR, Lee S, et al. Physiology of human cortical neurons adjacent to cavernous malformations and tumors. Epilepsia, 2003, 44(11): 1413-1419.
2.	Rosenow F, Alonso-Vanegas MA, Baumgartner C, et al. 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.
3.	吴红记, 于洮, 赵元立. 儿童颅内海绵状血管瘤并发癫痫的手术治疗. 国际神经病学神经外科学杂志, 2015, 42(4): 342-345.
4.	Rocamora R, Mader I, Zentner J, et al. Epilepsy surgery in patients with multiple cerebral cavernous malformations. Seizure, 2009, 18(4): 241-245.
5.	Menzler K, Thiel P, Hemsen A, et al. The role of underlying structural cause for epilepsy classification: clinical features and prognosis in mesial temporal lobe epilepsy caused by hippocampal sclerosis versus cavernoma. Epilepsia, 2011, 52(4): 707-711.
6.	von der Brelie C, Schramm J. Cerebral cavernous malformations and intractable epilepsy: the limited usefulness of current literature. Acta Neurochir (Wien), 2011, 153(2): 249-259.
7.	Kivelev J, Niemel M, Hernesniemi J. Characteristics of cavernomas of the brain and spine. J Clin Neurosci, 2012, 19(5): 643-648.
8.	李玲, 李铮. 颅内海绵状血管瘤诊断中 CT 和 MRI 的应用研究. 影像研究与医学应用, 2019, 3(4): 39-40.
9.	胡海清. 1. 5T 磁敏感加权成像在颅内海绵状血管瘤诊断中的应用价值. 医学装备, 2019, 32(6): 18-19.
10.	宋美香, 王伟, 刘卫平, 等. 颅内海绵状血管瘤致癫痫发作的脑电图探讨. 潍坊医学院学报, 2008, 30(5): 462-463.
11.	刘仕勇, 阴金波, 安宁, 等. 丙泊酚 Wada 实验在颞叶癫痫功能评估中的应用. 立体定向和功能性神经外科杂志, 2011, 24(1): 26-29.
12.	侯智, 李维, 安宁, 等. 56 例颅内海绵状血管瘤伴癫痫手术疗效分析. 第三军医大学学报, 2016, 38(17): 1987-1990.
13.	Amato MC, Madureira JF, Oliveira RS. Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases. Arq Neuropsiquiatr, 2013, 71(4): 220-228.
14.	Abla AA, Lekovie GP, Garrett M, et al. Cavernous malformations of the brainstem presenting in childhood: surgical experience in 40 patients. Neurosurgery, 2010, 67(6): 1589-1598.
15.	Reinacher PC, Van Velthoven V. Intraoperative ultrasound imaging: practical applicability as a real-time navigation system. Acta Neurochir Suppl, 2003, 85: 89-93.
16.	Yang I, Barbaro NM. Advances in the radiosurgical treatment of epilepsy. Epilepsy Curr, 2007, 7(2): 31-35.

1. Williamson A, Patrylo PR, Lee S, et al. Physiology of human cortical neurons adjacent to cavernous malformations and tumors. Epilepsia, 2003, 44(11): 1413-1419.
2. Rosenow F, Alonso-Vanegas MA, Baumgartner C, et al. 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.
3. 吴红记, 于洮, 赵元立. 儿童颅内海绵状血管瘤并发癫痫的手术治疗. 国际神经病学神经外科学杂志, 2015, 42(4): 342-345.
4. Rocamora R, Mader I, Zentner J, et al. Epilepsy surgery in patients with multiple cerebral cavernous malformations. Seizure, 2009, 18(4): 241-245.
5. Menzler K, Thiel P, Hemsen A, et al. The role of underlying structural cause for epilepsy classification: clinical features and prognosis in mesial temporal lobe epilepsy caused by hippocampal sclerosis versus cavernoma. Epilepsia, 2011, 52(4): 707-711.
6. von der Brelie C, Schramm J. Cerebral cavernous malformations and intractable epilepsy: the limited usefulness of current literature. Acta Neurochir (Wien), 2011, 153(2): 249-259.
7. Kivelev J, Niemel M, Hernesniemi J. Characteristics of cavernomas of the brain and spine. J Clin Neurosci, 2012, 19(5): 643-648.
8. 李玲, 李铮. 颅内海绵状血管瘤诊断中 CT 和 MRI 的应用研究. 影像研究与医学应用, 2019, 3(4): 39-40.
9. 胡海清. 1. 5T 磁敏感加权成像在颅内海绵状血管瘤诊断中的应用价值. 医学装备, 2019, 32(6): 18-19.
10. 宋美香, 王伟, 刘卫平, 等. 颅内海绵状血管瘤致癫痫发作的脑电图探讨. 潍坊医学院学报, 2008, 30(5): 462-463.
11. 刘仕勇, 阴金波, 安宁, 等. 丙泊酚 Wada 实验在颞叶癫痫功能评估中的应用. 立体定向和功能性神经外科杂志, 2011, 24(1): 26-29.
12. 侯智, 李维, 安宁, 等. 56 例颅内海绵状血管瘤伴癫痫手术疗效分析. 第三军医大学学报, 2016, 38(17): 1987-1990.
13. Amato MC, Madureira JF, Oliveira RS. Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases. Arq Neuropsiquiatr, 2013, 71(4): 220-228.
14. Abla AA, Lekovie GP, Garrett M, et al. Cavernous malformations of the brainstem presenting in childhood: surgical experience in 40 patients. Neurosurgery, 2010, 67(6): 1589-1598.
15. Reinacher PC, Van Velthoven V. Intraoperative ultrasound imaging: practical applicability as a real-time navigation system. Acta Neurochir Suppl, 2003, 85: 89-93.
16. Yang I, Barbaro NM. Advances in the radiosurgical treatment of epilepsy. Epilepsy Curr, 2007, 7(2): 31-35.

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