Risk Factors for Poor Postoperative Outcome and Epileptic Symptoms in Patients Diagnosed with Cerebral Cavernous Malformations

Background and Study Objective Roughly 12 to 47% of individuals with cerebral cavernous malformations (CCM) are asymptomatic, while other people may present with symptoms such as epileptic seizures, neurologic deficits, and intracerebral hemorrhages (IH). The aim of this study was to report our experience of postoperative outcomes of patients diagnosed with CCMs. Patients and Methods We present a series of consecutive patients who underwent surgical treatment for a diagnosed CCM between January 2003 and March 2014. Data were retrospectively analyzed with respect to preoperative visits, operating reports, patient admission charts, and postoperative follow-up visits. The Engel scale was used to evaluate the outcome of patients with epileptic seizures. Results A total of 91 patients were included with a mean age of 38.8 ± 15 years (range: 2–72 years). Prior to surgery, 57 of these patients had epileptic seizures, while 25 patients recorded at least one episode of IH with a latency time of 6.7 ± 8.5 years (range: 3–240 months) in between hemorrhages. A CCM located within the brainstem was significantly associated with IH prior to surgery (p = 0.000). If the CCM was adjacent to an eloquent brain area, the postoperative outcome in terms of seizure control was significantly worse (p = 0.033). In addition, a trend for worsened outcomes according to the Engel scale was observed in patients with more than one seizure prior to surgery (p = 0.055). Conclusion Proximity of CCMs to eloquent brain areas is a risk factor for poor postoperative outcome with respect to a lower rate of medication reduction as well as a lower rate of epileptic seizure omission. This underlines the importance of patient-specific therapeutic approaches.

Postoperative Outcome of Cerebral Amyloid Angiopathy-Related Lobar Intracerebral Hemorrhage

BACKGROUND Despite its accessible superficial location, the indication for surgical evacuation in cases of lobar intracerebral hemorrhage (LICH) suspected to be related to cerebral amyloid angiopathy (CAA) is controversial because of advanced patient age and concerns about postoperative hemostasis. OBJECTIVE To examine factors associated with postoperative outcome in CAA-related LICH. METHODS Review of consecutive patients with pathologically proven CAA who underwent LICH evacuation at Saint Marys Hospital, Rochester, Minnesota, between 1987 and 2006. End points were length of stay and postoperative outcome at discharge and last follow-up using the Glasgow Outcome Scale. We also performed a systematic review of all published studies evaluating the outcome of surgically treated CCA-related LICH published between 1984 and 2010. RESULTS We identified 23 patients with CAA-related LICH treated surgically. Favorable outcome (Glasgow Outcome Scale >3) at discharge was noted in 5 patients (22%), and at 6- to 12-month follow-up (n = 15) in 7 patients (47%). Three (13%) died in the hospital, including 1 of 4 patients with postoperative hemorrhage. Intraventricular hemorrhage (IVH) was associated with poor outcome at discharge. Older age (≥75 years), history of hypertension, and degree of preoperative midline shift were associated with more prolonged length of stay. In our systematic review, we identified 14 studies including 278 cases. Overall mortality rate was 25%, and poor postoperative outcome was associated with older age, IVH, and preoperative dementia. CONCLUSION Neurosurgical evacuation may be performed with acceptable safety in patients with CAA-related LICH. A systematic literature review indicates that older age, preexistent dementia, and presurgical IVH portend poor postoperative outcome.