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

Zanello, Marc; Goodden, John R.; Colle, Henry; Wager, Michel; Hamer, Philip C. De Witt; Smits, Anja; Bello, Lorenzo; Tate, Matthew; Spena, Giannantonio; Bresson, Damien; Capelle, Laurent; Robles, Santiago Gil; Sarubbo, Silvio; Rydenhag, Bertil; Martino, Juan; Meyer, Bernhard; Fontaine, Denys; Reyns, Nicolas; Schichor, Christian; Metellus, Philippe; Colle, David; Robert, Erik; Noens, Bonny; Muller, Peter; Rossi, Marco; Nibali, Marco Conti; Papagno, Costanza; Galbarritu, Lara; de Gopegui, Edurne Ruiz; Chioffi, Franco; Bucheli, Carlos; Krieg, Sandro M.; Wostrack, Maria; Yusupov, Natan; Visser, Victoria; Baaijen, Johannes C.; Roux, Alexandre; Dezamis, Edouard; Mandonnet, Emmanuel; Corns, Robert; Duffau, Hugues und Pallud, Johan (2019): Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas. In: Neurosurgery, Bd. 85, Nr. 4, E702-E713

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.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0148-396X
• Sprache: Englisch