Authors: Juri Kivelev Mika Niemelä Göran Blomstedt Reina Roivainen Martin Lehecka Juha Hernesniemi
Publish Date: 2010/09/26
Volume: 153, Issue: 2, Pages: 261-270
Abstract
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 longterm outcome In the present study a postoperative outcome is assessedOf our 360 consecutive patients with cerebral cavernomas 53 15 had a single cavernoma in the temporal lobe Fortynine 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 followup data all available patients were interviewed by phone Seizure outcome was assessed using the Engel classification and general outcome using the Glasgow Outcome Scale GOSPatients’ median age at presentation was 37 range 7–64 years with a female/male ratio of 251 Epileptic seizures occurred in 40 patients 82 Median duration of seizures preoperatively was 3 range 01–23 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 followup time was 6 range 02–26 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 followup Good general outcome GOS 45 was detected in 46 patients 96 Two patients 4 developed a new mild memory deficit after surgery and in two patients existing memory deficits worsenedThe results presented in this retrospective analysis of patients who underwent microsurgery for temporal lobe cavernomas are very much in keeping with the available literature Excising lesion is successful Engel class I and II in 90 of cases The abstract seems to play down the complication rate as seen in Table 5 at discharge 24 had morbidity 6 of these was related to the craniotomy acute subdural haematoma meningitis wound infection and thus it is considered temporary but the permanent neurological visual deficit coordination and neuropsychological memory dysphasia morbidity was 18This paper provides useful information about the relative importance of location of the lesion within the temporal lobe as far as the outcome is concerned Also it is interesting to note that contrary to the received wisdom lengthy history of epilepsy is not necessarily a bad prognostic feature However increased severity of the seizure disorder frequency diminishes the benefit
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