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Seizure. 2019 Mar 28;69:31-40. doi: 10.1016/j.seizure.2019.03.022. [Epub ahead of print]

Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers.

Author information

1
Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France.
2
Department of Neurosurgery, Technical University of Munich School of Medicine, Munich, Germany.
3
Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
4
Department of Neurosurgery, St Lucas Hospital, Gand, Belgium.
5
Neurosurgical Clinic, University of Munich - Campus Grosshadern, Munich, Germany.
6
Department of Neurosurgery, Humanitas Hospital, Milan, Italy.
7
Department of Neurosurgery, La Milétrie University Hospital, 86021 Poitiers, France.
8
Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden.
9
Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, USA.
10
Department of Neurosurgery, Clairval Private Hospital, Marseille, France.
11
Department of Neurosurgery, VU University Medical Center, Amsterdam, Netherlands.
12
Department of Neurosurgery, ASST Spedali Civili, Brescia, Italy.
13
Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France.
14
Department of Neurosurgery, Lariboisière Hospital, Paris, France.
15
Department of Neurosurgery, Hospital Universitario Quironsalud, Madrid, Spain.
16
Department of Neurosurgery, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.
17
Department of Neurosurgery, Marqués de Valdecilla University Hospital, Santander, Spain.
18
Department of Neurosurgery, Nice University Hospital, Nice, France.
19
Department of Neurosurgery, Roger-Salengro University Hospital, Lille, France.
20
Department of Neurophysiology, Pitié-Salpêtrière Hospital, UPMC, Sorbonne Université, Paris, France; Infantile Epilepsy and Brain Plasticity, INSERM U1129 Paris Descartes University, PRES Sorbonne, Paris, France; Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, Paris, France.
21
CIMeC, University of Trento, Italy.
22
Neurosurgery Department, Hôpital Gui-de-Chauliac, Montpellier University Medical Center, 34000 Montpellier, France.
23
Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France. Electronic address: j.pallud@ghu-paris.fr.

Abstract

PURPOSE:

The practical management of cavernous angioma located within eloquent brain area before, during and after surgical resection is poorly documented. We assessed the practical pre-operative, intra-operative, and post-operative management of cavernous angioma located within eloquent brain area.

METHOD:

An online survey composed of 61 items was sent to 26 centers to establish a multicenter international retrospective cohort of adult patients who underwent a surgical resection as the first-line treatment of a supratentorial cavernous angioma located within or close to eloquent brain area.

RESULTS:

272 patients from 19 centers (mean 13.6 ± 16.7 per center) from eight countries were included. The pre-operative management varied significantly between centers and countries regarding the pre-operative functional assessment, the pre-operative epileptological assessment, the first given antiepileptic drug, and the time to surgery. The intra-operative environment varied significantly between centers and countries regarding the use of imaging systems, the use of functional mapping with direct electrostimulations, the extent of resection of the hemosiderin rim, the realization of a post-operative functional assessment, and the time to post-operative functional assessment. The present survey found a post-operative improvement, as compared to pre-operative evaluations, of the functional status, the ability to work, and the seizure control.

CONCLUSIONS:

We observed a variety of practice between centers and countries regarding the management of cavernous angioma located within eloquent regions. Multicentric prospective studies are required to solve relevant questions regarding the management of cavernous angioma-related seizures, the timing of surgery, and the optimal extent of hemosiderin rim resection.

KEYWORDS:

Cavernous angioma; Epilepsy; Intra-operative brain mapping; Outcome; Return to work

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