2022 Volume 50 Issue 6 Pages 467-473
It is important to confirm the epileptogenic nature of a cavernous angioma before performing epilepsy surgery. Although some patients with epilepsy have cavernous angiomas, the lesions may not always be responsible for their seizures, and resection may not result in postoperative seizure control.
For such patients, when the ictal symptoms are consistent with the localization of the cavernous angioma on both magnetic resonance imaging (MRI) and electroencephalography (EEG), the angioma may be considered epileptogenic. However, if the ictal symptoms are not consistent with imaging and EEG findings, simultaneous video-EEG recordings of the seizures or events can be useful. Intracranial electrocorticography recordings may also help to accurately verify the relationship between the electrical seizure onset and the localization of the cavernous angioma on MRI.
Considering the surgical strategies for the management of a cavernous angioma, it is important to not only resect the angioma itself but the surrounding hemosiderin deposits as well, which, according to several reports, are epileptogenic. When the cavernous angioma is located apart from eloquent areas such as the primary motor, sensory, and language cortices, the whole gyrus, including the cavernous angioma, can be removed. Further, when the cavernous angioma is located in the medial temporal lobe, resection of the hippocampus and amygdala, as well as the angioma, is likely to improve seizure outcomes in patients.
