caa a22 4500 606216979 CHVBK 20210128101105.0 cr unu---uuuuu 210128e20151101xx s 000 0 eng 10.1007/s00701-015-2592-4 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2592-4 Temporal lobe epilepsy and cavernous malformations: surgical strategies and long-term outcomes [Elektronische Daten] [Fernando Vale, Andrew Vivas, Jotham Manwaring, Mike Schoenberg, Selim Benbadis] 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. Springer-Verlag Wien, 2015 Epilepsy nationallicence Cavernous malformation nationallicence Temporal lobe nationallicence Pathology nationallicence MTLE : Mesial temporal lobe epilepsy nationallicence MTS : Mesial temporal sclerosis nationallicence ECoG : Electrocorticography nationallicence MRI : Magnetic resonance imaging nationallicence CCM : Cerebral cavernous malformations nationallicence EC : Engel classification nationallicence EEG : Electroencephalography nationallicence Vale Fernando Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA aut Vivas Andrew Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA aut Manwaring Jotham Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA aut Schoenberg Mike Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA aut Benbadis Selim Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA aut Acta Neurochirurgica Springer Vienna 157/11(2015-11-01), 1887-1895 0001-6268 157:11<1887 2015 157 701 https://doi.org/10.1007/s00701-015-2592-4 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2592-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Vale Fernando Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA aut NATIONALLICENCE 700 1- Vivas Andrew Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA aut NATIONALLICENCE 700 1- Manwaring Jotham Department of Neurosurgery & Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA aut NATIONALLICENCE 700 1- Schoenberg Mike Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA aut NATIONALLICENCE 700 1- Benbadis Selim Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/11(2015-11-01), 1887-1895 0001-6268 157:11<1887 2015 157 701