Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas - Université Paris Cité Accéder directement au contenu
Article Dans Une Revue Neurosurgery Année : 2019

Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas

1 Centre Hospitalier Sainte Anne [Paris]
2 U894 - Centre de Psychiatrie et Neurosciences
3 LGI - Leeds General Infirmary
4 Department of Neurosurgery
5 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
6 VU University Medical Center [Amsterdam]
7 Sahlgrenska Academy at University of Gothenburg [Göteborg]
8 Uppsala University Hospital
9 Humanitas Clinical and Research Center [Rozzano, Milan, Italy]
10 Feinberg School of Medicine
11 Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia [Brescia]
12 Hôpital Lariboisière-Fernand-Widal [APHP]
13 CHU Pitié-Salpêtrière [AP-HP]
14 Hospital Universitario Quironsalud
15 Department of Neurosciences, Division of Neurosurgery, “S. Chiara” Hospital, Trento APSS – 9 Largo Medaglie D’Oro, Trento, 38122, Italy
16 GU - Göteborgs Universitet = University of Gothenburg
17 Hospital Universitario Marqués de Valdecilla [Santander]
18 TUM - Technische Universität Munchen - Technical University Munich - Université Technique de Munich
19 CHU Nice - Centre Hospitalier Universitaire de Nice
20 Hôpital Roger Salengro [Lille]
21 University-Hospital Munich-Großhadern [München]
22 Hôpital Privé Clairval [Marseille]
23 Department of Neurosurgery
24 Department of Neurosurgery
25 Department of Neurosurgery
26 CIMEC - Center for Mind/Brain Sciences
27 Hospital Universitario Cruces = Cruces University Hospital
28 MRI TUM - Klinikum rechts der Isar
29 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
30 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
Matthew Tate

Résumé

The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area. 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.

Dates et versions

hal-02870373 , version 1 (16-06-2020)

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Citer

Marc Zanello, John Goodden, Henry Colle, Michel Wager, Philip Hamer, et al.. Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas. Neurosurgery, 2019, 85 (4), pp.E702-E713. ⟨10.1093/neuros/nyz063⟩. ⟨hal-02870373⟩
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