Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas.
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Zanello Marc, Goodden John R, Colle Henry, Wager Michel, Hamer Philip C De Witt, Smits Anja, Bello Lorenzo, Tate Matthew, Spena Giannantonio, Bresson Damien, Capelle Laurent, Robles Santiago Gil, Sarubbo Silvio, Rydenhag Bertil, Martino Juan, Meyer Bernhard, Fontaine Denys, Reyns Nicolas, Schichor Christian, Metellus Philippe, Colle David, Robert Erik, Noens Bonny, Muller Peter, Rossi Marco, Nibali Marco Conti, Papagno Costanza, Galbarritu Lara, de Gopegui Edurne Ruiz, Chioffi Franco, Bucheli Carlos, Krieg Sandro M, Wostrack Maria, Yusupov Natan, Visser Victoria, Baaijen Johannes C, Roux Alexandre, Dezamis Edouard, Mandonnet Emmanuel, Corns Robert, Duffau Hugues, Pallud Johan
Аннотация
OBJECTIVE: To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.