Format

Send to

Choose Destination
Neurosurgery. 2019 Mar 29. pii: nyz063. doi: 10.1093/neuros/nyz063. [Epub ahead of print]

Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas.

Author information

1
Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
2
Sorbonne Paris Cité, Paris Descartes University, Paris, France.
3
Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France.
4
Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
5
Department of Neurosurgery, St Lucas Hospital, Gand, Belgium.
6
Department of Neurosurgery, La Milétrie University Hospital, Poitiers, France.
7
Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, Netherlands.
8
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
9
Department of Neuroscience, Neurology, Uppsala University, University Hospital, Uppsala, Sweden.
10
NeuroOncological Surgery Unit, Humanitas Research Hospital, Milano, Italy.
11
Departments of Neurological Surgery and Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
12
Department of Neurosurgery, ASST Spedali Civili, Brescia, Italy.
13
Department of Neurosurgery, Lariboisière Hospital, Paris, France.
14
Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France.
15
Department of Neurosurgery, Hospital Universitario Quironsalud, Madrid, Spain.
16
Division of Neurosurgery, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, APSS Trento, Italy.
17
Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla (HUMV) and Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
18
Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
19
Department of Neurosurgery, Nice University Hospital, Nice, France.
20
Department of Neurosurgery, Roger-Salengro University Hospital, Lille, France.
21
Neurosurgical Clinic, University of Munich - Campus Grosshadern, Munich, Germany.
22
Department of Neurosurgery, Clairval Private Hospital, Marseille, France.
23
Center for Neurocognitive Rehabilitation (CeRiN), CIMeC, University of Trento, Trento, Italy.
24
Neurosurgery, Cruces University Hospital, Barakaldo, Basque Country, Spain.
25
Neurosurgery Department, Hôpital Gui-de-Chauliac, Montpellier University Medical Center, Montpellier, France.

Abstract

BACKGROUND:

The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area.

OBJECTIVE:

To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery.

METHODS:

Multicenter international retrospective cohort analysis of adult patients benefitting from a functional-based surgical resection with intraoperative functional brain mapping for a supratentorial CA within or close to eloquent brain areas.

RESULTS:

A total of 109 patients (66.1% women; mean age 38.4 ± 12.5 yr), were studied. Age >38 yr (odds ratio [OR], 7.33; 95% confidence interval [CI], 1.53-35.19; P = .013) and time to surgery > 12 mo (OR, 18.21; 95% CI, 1.11-296.55; P = .042) are independent predictors of uncontrolled seizures at the time of surgery. Focal deficit (OR, 10.25; 95% CI, 3.16-33.28; P < .001) is an independent predictor of inability to work at the time of surgery. History of epileptic seizures at the time of surgery (OR, 7.61; 95% CI, 1.67-85.42; P = .003) and partial resection of the CA and/or of the hemosiderin rim (OR, 12.02; 95% CI, 3.01-48.13; P < .001) are independent predictors of uncontrolled seizures postoperatively. Inability to work at the time of surgery (OR, 19.54; 95% CI, 1.90-425.48; P = .050), Karnofsky Performance Status ≤ 70 (OR, 51.20; 95% CI, 1.20-2175.37; P = .039), uncontrolled seizures postoperatively (OR, 105.33; 95% CI, 4.32-2566.27; P = .004), and worsening of cognitive functions postoperatively (OR, 13.71; 95% CI, 1.06-176.66; P = .045) are independent predictors of inability to work postoperatively.

CONCLUSION:

The functional-based resection using intraoperative functional brain mapping allows safe resection of CA and the peripheral hemosiderin rim located within or close to eloquent brain areas.

KEYWORDS:

Cavernous angioma; Epilepsy; Intraoperative brain mapping; Outcome; Return to work; Seizures; Surgery

PMID:
30924504
DOI:
10.1093/neuros/nyz063

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center