SURGICAL OUTCOME IN PATIENTS WITH EPILEPSY WITH OCCULT VASCULAR MALFORMATIONS TREATED WITH LESIONECTOMY

Purpose: This retrospective study reports the long-term surgical outco me of patients with medically refractory epilepsy and vascular malform ations who were treated with lesionectomy. A detailed analysis of surg ical failures had been performed in an attempt to define predictors of surgical success and failure. Methods: Fifteen patients with medicall y intractable epilepsy and angiographically occult vascular malformati ons (AOVMs) were treated surgically with lesionectomy at Duke Universi ty Medical Center. Lesionectomy consisted of removal of the AOVM and s urrounding hemosiderin-stained brain only, without the use of electroc orticography (ECoG) to guide resection. Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant impr ovement, and one patient died, presumably after a seizure. Age of onse t, duration of seizures, age at resection, and gender did not affect o utcome. All patients with neocortical AOVMs in whom EEG findings corre lated with the site of the lesion were seizure free after lesional res ection. Treatment failures were associated with the presence of multip le intracranial lesions, poorly localized or diffuse EEG findings, dis cordant positron emission tomography (PET) imaging, or with a lesion i n close proximity to the limbic system. Conclusions: Lesionectomy, wit h removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy w ith occult vascular malformations.