Clinical Pathological Findings And Analysis Of Postoperative Outcomes Of Cerebral Cavernous Malformations Presenting With Seizure

Object: Seizure is the main manifestation of cerebral cavernous malformations(CCMs).In this study,we evaluate the clinical features,electrocorticography(ECo G)results and clinical pathological findings of CCM patients and identify risk factors for seizure outcomes.Methods: A prospectively maintained database of CCM patients referred to our hospital was reviewed to identify all consecutive surgically treated(ECo G-guided extended lesionectomy)CCM-related epilepsy(CRE)patients.CCMs,the surrounding haemosiderin and detected epileptic foci were removed and intraoperative ECo G results and postoperative pathological findings documented.Engel Class I and II-IV were defined as satisfactory and unsatisfactory outcomes,respectively.Patient follow-up was at least 2 years.The relationships between ECo G results and clinical pathological findings s and seizure outcomes were analysed.Results: In all,85 epileptic CCM patients were included.There were 45 males and 40 females,aged 4-64 years,with an average age of 32.4±14.0 years,followed up for 2-11 years,with an average age of 41.32±73.17 months.at the last clinical visit,only 83.5%had achieved satisfactory outcomes.Univariate analysis revealed that the long course of seizure,the long duration of preoperative antiepileptic drug treatment,the refractory epilepsy,the deep CCM,the temporal lobe CCM,concomitant focal cortical dysplasia(FCD),gliosis,and ECo G residuals after resection were associated with poor prognosis.After epileptic foci resection,no ECo G residuals were detected in 65 patients,including60(92.3%)who achieved satisfactory outcomes.Most(61,93.8%)of the 65 CRE patients without FCD achieved satisfactory outcomes.Multivariate analysis revealed that the detection of post-excision residual epileptic waves on intraoperative ECo G(OR13.64;CI 2.13-87.11;p=0.006)and concomitant FCD(OR 11.37;CI 1.63-79.27;p=0.014)were independently significantly correlated with seizure outcomes.Conclusion: The detection of residual epileptic waves on intraoperative ECo G and concomitant FCD in pathological finding may be associated with poorer long-term seizure outcomes.Close follow-up might be needed in these patients.