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Acta Neurochirurgica
Published in: Acta Neurochirurgica 2/2011

01-02-2011 | Clinical Article

Microsurgical treatment of temporal lobe cavernomas

Authors: Juri Kivelev, Mika Niemelä, Göran Blomstedt, Reina Roivainen, Martin Lehecka, Juha Hernesniemi

Published in: Acta Neurochirurgica | Issue 2/2011

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Abstract

Background

Cavernomas of the temporal lobe occur in 10–20% of patients with cerebral cavernomas. They frequently cause epileptic seizures, some of which tend to become refractory to medical therapy. Surgical removal of safely achievable symptomatic lesions has been frequently consistent with good long-term outcome. In the present study, a postoperative outcome is assessed.

Methods

Of our 360 consecutive patients with cerebral cavernomas, 53 (15%) had a single cavernoma in the temporal lobe. Forty-nine patients were treated surgically and were included in the study. All data were analyzed retrospectively. The cavernomas were allocated into three groups based on the temporal lobe site: medial, anterolateral, and posterolateral. To collect follow-up data, all available patients were interviewed by phone. Seizure outcome was assessed using the Engel classification and general outcome using the Glasgow Outcome Scale (GOS).

Results

Patients’ median age at presentation was 37 (range, 7–64) years, with a female/male ratio of 2.5:1. Epileptic seizures occurred in 40 patients (82%). Median duration of seizures preoperatively was 3 (range, 0.1–23) years. In addition, four patients (10%) had memory disorder. Three patients without history of seizures (6%) complained of headache and two (4%) had memory problems. Three patients (6%) had an incidental cavernoma. Hemorrhage occurred in nine patients (18%) preoperatively. Median postoperative follow-up time was 6 (range, 0.2–26) years. Favorable seizure outcome (Engel class I and II) was registered in 35 patients (90%). Ten patients (25%) who had only a single seizure before surgery were seizure free during postoperative follow-up. Good general outcome (GOS, 4.5) was detected in 46 patients (96%). Two patients (4%) developed a new mild memory deficit after surgery, and in two patients existing memory deficits worsened.

Conclusions

Microsurgical removal of temporal lobe cavernomas is a safe and effective method to improve seizure outcome in patients with medically intractable epilepsy and to prevent deterioration caused by hemorrhage.
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Metadata
Title
Microsurgical treatment of temporal lobe cavernomas
Authors
Juri Kivelev
Mika Niemelä
Göran Blomstedt
Reina Roivainen
Martin Lehecka
Juha Hernesniemi
Publication date
01-02-2011
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 2/2011
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-010-0812-5

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