Seizure outcome in patients with cavernous malformation after early surgery.
OBJECTIVE
To describe seizure outcome and complications in patients with cavernous malformations (CM) undergoing early versus late surgery.


METHODS
A database was created for all CM patients who presented with seizure referred to the neurosurgical clinic at an academic center. A telephone survey and chart review were conducted to evaluate for preoperative and postoperative seizure frequency. Postoperative seizure-free outcome of patients who had ≤2 preoperative seizures versus those that had >2 preoperative seizures was compared.


RESULTS
A total of 35 CM patients were included for analysis. Nineteen patients had ≤2 preoperative seizures and 16 patients had >2 preoperative seizures, six of them drug resistant for over two years. Among the ≤2 seizure group, 15 had only a single seizure before surgical resection. 94.7% of patients with ≤2 preoperative seizures and 62.5% of patients with >2 preoperative seizures were seizure free one year following surgical resection (p = 0.019). 78.9% of patients with ≤2 preoperative seizures and 25% of patients with >2 preoperative seizures were able to wean off AEDs (p < 0.001). Among those patients who had a single preoperative seizure, 100% of patients were seizure free at one year.


CONCLUSIONS
Early surgical resection for CM patients who present after a CM-related seizure is an effective, well tolerated treatment and has good chance to offer seizure freedom without the need for long-term antiepileptic medications. Outcome for patients operated with only one or two preoperative seizures may lead to better results than patients who delay the procedure.
['Kapadia|Manish|M|', 'Walwema|Marianne|M|', 'Smith|Timothy R|TR|', 'Bellinski|Irena|I|', 'Batjer|Hunt|H|', 'Getch|Christopher|C|', 'Rosenow|Joshua M|JM|', 'Bendok|Bernard R|BR|', 'Schuele|Stephan U|SU|']
D000927:Anticonvulsants D020786:Hemangioma, Cavernous, Central Nervous System D006801:Humans D012189:Retrospective Studies D012640:Seizures D016896:Treatment Outcome
Cavernous malformation Cavernoma Epilepsy surgery First seizure Intractable epilepsy