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.

Predictors of epileptic seizures and ability to work in supratentorial cavernous angioma located within eloquent brain areas / M. Zanello, J.R. Goodden, H. Colle, M. Wager, P.C.D.W. Hamer, A. Smits, L. Bello, M. Tate, G. Spena, D. Bresson, L. Capelle, S.G. Robles, S. Sarubbo, B. Rydenhag, J. Martino, B. Meyer, D. Fontaine, N. Reyns, C. Schichor, P. Metellus, D. Colle, E. Robert, B. Noens, P. Muller, M. Rossi, M.C. Nibali, C. Papagno, L. Galbarritu, E.R. De Gopegui, F. Chioffi, C. Bucheli, S.M. Krieg, M. Wostrack, N. Yusupov, V. Visser, J.C. Baaijen, A. Roux, E. Dezamis, E. Mandonnet, R. Corns, H. Duffau, J. Pallud. - In: NEUROSURGERY. - ISSN 0148-396X. - 85:4(2019 Oct), pp. E702-E713. [10.1093/neuros/nyz063]

Predictors of epileptic seizures and ability to work in supratentorial cavernous angioma located within eloquent brain areas

L. Bello;M. Rossi;
2019-10

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.
cavernous angioma; epilepsy; intraoperative brain mapping; outcome; return to work; seizures; surgery; adult; brain mapping; brain neoplasms; cohort studies; female; follow-up studies; hemangioma, cavernous; humans; internationality; male; middle aged; predictive value of tests; retrospective studies; seizures; Karnofsky performance status
Settore MED/27 - Neurochirurgia
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/904065
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