Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers.
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Zanello Marc, Meyer Bernhard, Still Megan, Goodden John R, Colle Henry, Schichor Christian, Bello Lorenzo, Wager Michel, Smits Anja, Rydenhag Bertil, Tate Matthew, Metellus Philippe, Hamer Philip De Witt, Spena Giannantonio, Capelle Laurent, Mandonnet Emmanuel, Robles Santiago Gil, Sarubbo Silvio, Martino González Juan, Fontaine Denys, Reyns Nicolas, Krieg Sandro M, Huberfeld Gilles, Wostrack Maria, Colle David, Robert Erik, Noens Bonny, Muller Peter, Yusupov Natan, Rossi Marco, Conti Nibali Marco, Papagno Costanza, Visser Victoria, Baaijen Hans, Galbarritu Lara, Chioffi Franco, Bucheli Carlos, Roux Alexandre, Dezamis Edouard, Duffau Hugues, Pallud Johan
Аннотация
METHOD: An online survey composed of 61 items was sent to 26 centers to establish a multicenter international retrospective cohort of adult patients who underwent a surgical resection as the first-line treatment of a supratentorial cavernous angioma located within or close to eloquent brain area.
RESULTS: 272 patients from 19 centers (mean 13.6 ± 16.7 per center) from eight countries were included. The pre-operative management varied significantly between centers and countries regarding the pre-operative functional assessment, the pre-operative epileptological assessment, the first given antiepileptic drug, and the time to surgery. The intra-operative environment varied significantly between centers and countries regarding the use of imaging systems, the use of functional mapping with direct electrostimulations, the extent of resection of the hemosiderin rim, the realization of a post-operative functional assessment, and the time to post-operative functional assessment. The present survey found a post-operative improvement, as compared to pre-operative evaluations, of the functional status, the ability to work, and the seizure control.
CONCLUSIONS: We observed a variety of practice between centers and countries regarding the management of cavernous angioma located within eloquent regions. Multicentric prospective studies are required to solve relevant questions regarding the management of cavernous angioma-related seizures, the timing of surgery, and the optimal extent of hemosiderin rim resection.