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

Journal article
Authors Marc Zanello
John R Goodden
Henry Colle
Michel Wager
Philip C De Witt Hamer
Anja Smits
Lorenzo Bello
Matthew Tate
Giannantonio Spena
Damien Bresson
Laurent Capelle
Santiago Gil Robles
Silvio Sarubbo
Bertil Rydenhag
Juan Martino
Bernhard Meyer
Denys Fontaine
Nicolas Reyns
Christian Schichor
Philippe Metellus
David Colle
Erik Robert
Bonny Noens
Peter Muller
Marco Rossi
Marco Conti Nibali
Costanza Papagno
Lara Galbarritu
Edurne Ruiz de Gopegui
Franco Chioffi
Carlos Bucheli
Sandro M Krieg
Maria Wostrack
Natan Yusupov
Victoria Visser
Johannes C Baaijen
Alexandre Roux
Edouard Dezamis
Emmanuel Mandonnet
Robert Corns
Hugues Duffau
Johan Pallud
Published in Neurosurgery
Volume 85
Issue 4
Pages E702–E713
ISSN 1524-4040
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Pages E702–E713
Language en
Links dx.doi.org/10.1093/neuros/nyz063
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Neurosurgery

Abstract

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.To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery.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.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.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.

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