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Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers

Marc Zanello, Bernhard Meyer, Megan Still, John R Goodden, Henry Colle, Christian Schichor, Lorenzo Bello, Michel Wager, Anja Smits, Bertil Rydenhag, Matthew Tate, Philippe Metellus, Philip De Witt Hamer, Giannantonio Spena, Laurent Capelle, Emmanuel Mandonnet, Santiago Gil Robles, Silvio Sarubbo, Juan Martino González, Denys Fontaine, Nicolas Reyns, Sandro M Krieg, Gilles Huberfeld, Maria Wostrack, David Colle, Erik Robert, Bonny Noens, Peter Muller, Natan Yusupov, Marco Rossi, Marco Conti Nibali, Costanza Papagno, Victoria Visser, Hans Baaijen, Lara Galbarritu, Franco Chioffi, Carlos Bucheli, Alexandre Roux, Edouard Dezamis, Hugues Duffau, Johan Pallud
Seizure: the Journal of the British Epilepsy Association 2019 March 28, 69: 31-40

PURPOSE: The practical management of cavernous angioma located within eloquent brain area before, during and after surgical resection is poorly documented. We assessed the practical pre-operative, intra-operative, and post-operative management of cavernous angioma located within eloquent brain area.

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.


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