Long-term seizure outcomes following resection of supratentorial cavernous malformations

Churl Su Kwon, Sameer A. Sheth, Brian P. Walcott, Jonathan Neal, Emad N. Eskandar, Christopher S. Ogilvy

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective Symptomatic supratentorial cavernous malformations may present with seizure, headache, neurological deficit, or a combination thereof. Factors that contribute to treatment algorithms commonly include patient age, lesion size and location, lesion multiplicity, hemorrhage history, and the ability to control seizure activity with medication. A better appreciation of the impact of patient and lesion characteristics on post-operative seizure control may provide insight into management strategies. To determine long-term seizure outcomes following surgical resection of supratentorial cavernous malformations, the predictive value of characteristics including seizure duration and number, presence of generalized seizures, and lesion multiplicity and size on seizure control rate was evaluated. Methods We performed a single institution retrospective review of consecutive patients with supratentorial cavernous malformations presenting with at least one seizure between 1995 and 2008. Univariate and multivariate analyses were used to determine the influence of patient and lesion characteristics on postoperative seizure control. Results Fifty-six patients met inclusion criteria. Mean follow-up duration was 87.9 months. At last follow-up there were 46 patients (82.1%) that were free from impairing seizures (Engel Class 1). Ten patients (17.9%) were classified as Engel Class 2-4. Univariate analysis demonstrated that only the presence of multiple cavernomas was associated with worse post-operative seizure outcome (p = 0.006). Multivariate analysis demonstrated that multiple cavernomas remained a significant predictor for development of worse seizure outcome controlling for number and duration of seizures prior to operation, presence of generalized tonic-clonic seizures, and size (odds ratio, 0.17; 95% confidence interval, 0.03, 0.99). Conclusion Resection of supratentorial cavernomas is associated with a high rate of postoperative seizure freedom. The presence of multiple cavernomas is predictive of seizure persistence following surgery.

Original languageEnglish (US)
Pages (from-to)2377-2381
Number of pages5
JournalClinical Neurology and Neurosurgery
Volume115
Issue number11
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

Fingerprint

Seizures
Multivariate Analysis
Headache
Odds Ratio
Confidence Intervals
Hemorrhage

Keywords

  • Cavernous malformation
  • Epilepsy
  • Multivariate analysis
  • Seizure
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Long-term seizure outcomes following resection of supratentorial cavernous malformations. / Kwon, Churl Su; Sheth, Sameer A.; Walcott, Brian P.; Neal, Jonathan; Eskandar, Emad N.; Ogilvy, Christopher S.

In: Clinical Neurology and Neurosurgery, Vol. 115, No. 11, 01.11.2013, p. 2377-2381.

Research output: Contribution to journalArticle

Kwon, Churl Su ; Sheth, Sameer A. ; Walcott, Brian P. ; Neal, Jonathan ; Eskandar, Emad N. ; Ogilvy, Christopher S. / Long-term seizure outcomes following resection of supratentorial cavernous malformations. In: Clinical Neurology and Neurosurgery. 2013 ; Vol. 115, No. 11. pp. 2377-2381.
@article{04f4d2c20c564c62ac1248dc29f1c61d,
title = "Long-term seizure outcomes following resection of supratentorial cavernous malformations",
abstract = "Objective Symptomatic supratentorial cavernous malformations may present with seizure, headache, neurological deficit, or a combination thereof. Factors that contribute to treatment algorithms commonly include patient age, lesion size and location, lesion multiplicity, hemorrhage history, and the ability to control seizure activity with medication. A better appreciation of the impact of patient and lesion characteristics on post-operative seizure control may provide insight into management strategies. To determine long-term seizure outcomes following surgical resection of supratentorial cavernous malformations, the predictive value of characteristics including seizure duration and number, presence of generalized seizures, and lesion multiplicity and size on seizure control rate was evaluated. Methods We performed a single institution retrospective review of consecutive patients with supratentorial cavernous malformations presenting with at least one seizure between 1995 and 2008. Univariate and multivariate analyses were used to determine the influence of patient and lesion characteristics on postoperative seizure control. Results Fifty-six patients met inclusion criteria. Mean follow-up duration was 87.9 months. At last follow-up there were 46 patients (82.1{\%}) that were free from impairing seizures (Engel Class 1). Ten patients (17.9{\%}) were classified as Engel Class 2-4. Univariate analysis demonstrated that only the presence of multiple cavernomas was associated with worse post-operative seizure outcome (p = 0.006). Multivariate analysis demonstrated that multiple cavernomas remained a significant predictor for development of worse seizure outcome controlling for number and duration of seizures prior to operation, presence of generalized tonic-clonic seizures, and size (odds ratio, 0.17; 95{\%} confidence interval, 0.03, 0.99). Conclusion Resection of supratentorial cavernomas is associated with a high rate of postoperative seizure freedom. The presence of multiple cavernomas is predictive of seizure persistence following surgery.",
keywords = "Cavernous malformation, Epilepsy, Multivariate analysis, Seizure, Surgery",
author = "Kwon, {Churl Su} and Sheth, {Sameer A.} and Walcott, {Brian P.} and Jonathan Neal and Eskandar, {Emad N.} and Ogilvy, {Christopher S.}",
year = "2013",
month = "11",
day = "1",
doi = "10.1016/j.clineuro.2013.08.024",
language = "English (US)",
volume = "115",
pages = "2377--2381",
journal = "Clinical Neurology and Neurosurgery",
issn = "0303-8467",
publisher = "Elsevier",
number = "11",

}

TY - JOUR

T1 - Long-term seizure outcomes following resection of supratentorial cavernous malformations

AU - Kwon, Churl Su

AU - Sheth, Sameer A.

AU - Walcott, Brian P.

AU - Neal, Jonathan

AU - Eskandar, Emad N.

AU - Ogilvy, Christopher S.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Objective Symptomatic supratentorial cavernous malformations may present with seizure, headache, neurological deficit, or a combination thereof. Factors that contribute to treatment algorithms commonly include patient age, lesion size and location, lesion multiplicity, hemorrhage history, and the ability to control seizure activity with medication. A better appreciation of the impact of patient and lesion characteristics on post-operative seizure control may provide insight into management strategies. To determine long-term seizure outcomes following surgical resection of supratentorial cavernous malformations, the predictive value of characteristics including seizure duration and number, presence of generalized seizures, and lesion multiplicity and size on seizure control rate was evaluated. Methods We performed a single institution retrospective review of consecutive patients with supratentorial cavernous malformations presenting with at least one seizure between 1995 and 2008. Univariate and multivariate analyses were used to determine the influence of patient and lesion characteristics on postoperative seizure control. Results Fifty-six patients met inclusion criteria. Mean follow-up duration was 87.9 months. At last follow-up there were 46 patients (82.1%) that were free from impairing seizures (Engel Class 1). Ten patients (17.9%) were classified as Engel Class 2-4. Univariate analysis demonstrated that only the presence of multiple cavernomas was associated with worse post-operative seizure outcome (p = 0.006). Multivariate analysis demonstrated that multiple cavernomas remained a significant predictor for development of worse seizure outcome controlling for number and duration of seizures prior to operation, presence of generalized tonic-clonic seizures, and size (odds ratio, 0.17; 95% confidence interval, 0.03, 0.99). Conclusion Resection of supratentorial cavernomas is associated with a high rate of postoperative seizure freedom. The presence of multiple cavernomas is predictive of seizure persistence following surgery.

AB - Objective Symptomatic supratentorial cavernous malformations may present with seizure, headache, neurological deficit, or a combination thereof. Factors that contribute to treatment algorithms commonly include patient age, lesion size and location, lesion multiplicity, hemorrhage history, and the ability to control seizure activity with medication. A better appreciation of the impact of patient and lesion characteristics on post-operative seizure control may provide insight into management strategies. To determine long-term seizure outcomes following surgical resection of supratentorial cavernous malformations, the predictive value of characteristics including seizure duration and number, presence of generalized seizures, and lesion multiplicity and size on seizure control rate was evaluated. Methods We performed a single institution retrospective review of consecutive patients with supratentorial cavernous malformations presenting with at least one seizure between 1995 and 2008. Univariate and multivariate analyses were used to determine the influence of patient and lesion characteristics on postoperative seizure control. Results Fifty-six patients met inclusion criteria. Mean follow-up duration was 87.9 months. At last follow-up there were 46 patients (82.1%) that were free from impairing seizures (Engel Class 1). Ten patients (17.9%) were classified as Engel Class 2-4. Univariate analysis demonstrated that only the presence of multiple cavernomas was associated with worse post-operative seizure outcome (p = 0.006). Multivariate analysis demonstrated that multiple cavernomas remained a significant predictor for development of worse seizure outcome controlling for number and duration of seizures prior to operation, presence of generalized tonic-clonic seizures, and size (odds ratio, 0.17; 95% confidence interval, 0.03, 0.99). Conclusion Resection of supratentorial cavernomas is associated with a high rate of postoperative seizure freedom. The presence of multiple cavernomas is predictive of seizure persistence following surgery.

KW - Cavernous malformation

KW - Epilepsy

KW - Multivariate analysis

KW - Seizure

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84886946135&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84886946135&partnerID=8YFLogxK

U2 - 10.1016/j.clineuro.2013.08.024

DO - 10.1016/j.clineuro.2013.08.024

M3 - Article

VL - 115

SP - 2377

EP - 2381

JO - Clinical Neurology and Neurosurgery

JF - Clinical Neurology and Neurosurgery

SN - 0303-8467

IS - 11

ER -