• Christian R Baumann, Nicola Acciarri, Helmut Bertalanffy, Orrin Devinsky, Christian E Elger, Giorgio Lo Russo, Massimo Cossu, Uli Sure, Anuradha Singh, Hermann Stefan, Tilo Hammen, Dimitrios Georgiadis, Ralf W Baumgartner, Frederick Andermann, and Adrian M Siegel.
• Department of Neurology, University Hospital, Zurich, Switzerland.
• Epilepsia. 2007 Mar 1;48(3):559-63.

PurposeThe optimal management of cerebral cavernous malformations (CCMs) with epileptic seizures is still a matter of debate. The aim of our study was to examine seizure outcome in the largest published series of surgically treated patients with epilepsy due to a supratentorial CCM, and to define predictors for good surgical outcome.MethodsWe retrospectively studied 168 consecutive patients with a single supratentorial CCM and symptomatic epilepsy in a multicenter study. Pre- and postoperative clinical examinations, age at epilepsy onset, age at operation, type of symptoms due to the CCM (seizures, headache, hemorrhage, focal deficits), type and frequency of epileptic seizures, and the localization and size of the CCM were assessed. Seizure outcome was determined in the first, second, and third postoperative years.ResultsThe CCM was completely resected in all patients. More than two thirds of the patients were classified as seizure free in the first 3 postoperative years. Predictors for good seizure outcome were age older than 30 years at the time of surgery, mesiotemporal CCM localization, CCM size <1.5 cm, and the absence of secondarily generalized seizures. No mortality occurred in our series, but only mild postoperative neurologic deficits in 12 (7%) patients.ConclusionsConsidering the natural history of CCMs, the favorable neurologic and seizure outcome, surgical resection of CCMs should be considered in all patients with supratentorial CCMs and concomitant epilepsy, irrespective of the presence or absence of predictors for a favorable seizure outcome.

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