Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas

Marc Zanello, John R. Goodden, Henry Colle, Michel Wager, Philip C.De Witt Hamer, Anja Smits, Lorenzo Bello, Matthew Tate, Giannantonio Spena, Damien Bresson, Laurent Capelle, Santiago Gil Robles, Silvio Sarubbo, Bertil Rydenhag, Juan Martino, Bernhard Meyer, Denys Fontaine, Nicolas Reyns, Christian Schichor, Philippe MetellusDavid Colle, Erik Robert, Bonny Noens, Peter Muller, Marco Rossi, Marco Conti Nibali, Costanza Papagno, Lara Galbarritu, Edurne Ruiz De Gopegui, Franco Chioffi, Carlos Bucheli, Sandro M. Krieg, Maria Wostrack, Natan Yusupov, Victoria Visser, Johannes C. Baaijen, Alexandre Roux, Edouard Dezamis, Emmanuel Mandonnet, Robert Corns, Hugues Duffau, Johan Pallud*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area. OBJECTIVE: To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery. METHODS: Multicenter international retrospective cohort analysis of adult patients benefitting from a functional-based surgical resection with intraoperative functional brain mapping for a supratentorial CA within or close to eloquent brain areas. RESULTS: A total of 109 patients (66.1% women; mean age 38.4 ± 12.5 yr), were studied. Age >38 yr (odds ratio [OR], 7.33; 95% confidence interval [CI], 1.53-35.19; P =. 013) and time to surgery > 12 mo (OR, 18.21; 95% CI, 1.11-296.55; P =. 042) are independent predictors of uncontrolled seizures at the time of surgery. Focal deficit (OR, 10.25; 95% CI, 3.16-33.28; P <. 001) is an independent predictor of inability to work at the time of surgery. History of epileptic seizures at the time of surgery (OR, 7.61; 95% CI, 1.67-85.42; P =. 003) and partial resection of the CA and/or of the hemosiderin rim (OR, 12.02; 95% CI, 3.01-48.13; P <. 001) are independent predictors of uncontrolled seizures postoperatively. Inability to work at the time of surgery (OR, 19.54; 95% CI, 1.90-425.48; P =. 050), Karnofsky Performance Status ≤ 70 (OR, 51.20; 95% CI, 1.20-2175.37; P =. 039), uncontrolled seizures postoperatively (OR, 105.33; 95% CI, 4.32-2566.27; P =. 004), and worsening of cognitive functions postoperatively (OR, 13.71; 95% CI, 1.06-176.66; P =. 045) are independent predictors of inability to work postoperatively. CONCLUSION: The functional-based resection using intraoperative functional brain mapping allows safe resection of CA and the peripheral hemosiderin rim located within or close to eloquent brain areas.

Original languageEnglish (US)
Pages (from-to)E702-E713
JournalClinical Neurosurgery
Volume85
Issue number4
DOIs
StatePublished - Oct 1 2019

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Keywords

  • Cavernous angioma
  • Epilepsy
  • Intraoperative brain mapping
  • Outcome
  • Return to work
  • Seizures
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Zanello, M., Goodden, J. R., Colle, H., Wager, M., Hamer, P. C. D. W., Smits, A., Bello, L., Tate, M., Spena, G., Bresson, D., Capelle, L., Robles, S. G., Sarubbo, S., Rydenhag, B., Martino, J., Meyer, B., Fontaine, D., Reyns, N., Schichor, C., ... Pallud, J. (2019). Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas. Clinical Neurosurgery, 85(4), E702-E713. https://doi.org/10.1093/neuros/nyz063