Cavernous Angiomas in Chronic Epilepsy Associated with Focal Cortical Dysplasia
Elizabeth R Severson, Derrick J Chen, Richard A Prayson. Cleveland Clinic, Cleveland, OH
Background: Both cavernous angiomas and focal cortical dysplasia (FCD) are well recognized causes of medically intractable epilepsy. In a subset of patients with chronic epilepsy, multiple pathologies may coexist (eg: focal cortical dysplasia adjacent to ganglioglioma or dysembryoplastic neuroepithelial tumor). Anecdotal causes of FCD adjacent to cavernous angiomas have been documented in the literature. This study systematically reviews a series of cavernous angiomas in epileptic patients, looking for evidence of coexistent FCD.
Design: One hundred forty six patients were diagnosed with cavernous angiomas on resection specimens from January, 1989, to May, 2011. Histologic slides were reviewed from these cases in order to confirm the diagnosis and to identify cases which had ample tissue adjacent to the lesion to evaluate for FCD. Eighteen cases who also had epilepsy qualified for study. FCD was classified according to criteria outlined by Palmini et al (Neurology 2004;62(Suppl 3)S2-8).
Results: Patients included 10 females (55.6%) and 8 males (44.4%) with a mean age of 38.5 years (median 39 years; range 21 to 51 years) at the time of resection. All patients had a history of epilepsy (median 11 years) prior to surgery. Seventeen cavernomas were located in the temporal lobe and one in the occipital lobe; 9 were located on the left side and 9 on the right side. Adjacent FCD was identified in 13 out of the 18 cases (72.2%). The FCD in these cases were classified as type Ia (N=8; 61.5%), type Ib (N=4; 30.8%), and type IIa (N=1; 7.7%). After resection, a majority of the patients experienced resolution of epilepsy (N=14; 77.8%). Of the four patients that did not experience resolution, 2 had evidence of adjacent FCD(type Ia = 1, type Ib = 1) and 2 did not.
Conclusions: Focal cortical dysplasia is frequently present in association with cavernous angiomas in patients with chronic epilepsy. The type of FCD seen adjacent to these lesions vary, but most are Palmini et al type I. With resection of the cavernous angiomas and adjacent FCD, resolution of epilepsy may be achieved.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 275, Tuesday Afternoon