Previous works showed that extent of resection and its surrounding hemosiderin rim were found to consistently correlate with a more favorable post-operative seizure-free outcome 7) 8). However, further well-designed prospective multiple-center RCT studies are still needed 6). Patients who underwent extended surrounding hemosiderin excision could exhibit significantly improved seizure outcomes compared to patients without hemosiderin excision. Meta-analyses, subgroup analyses and sensitivity analysis were conducted to determine the association between hemosiderin excision and seizure outcome after surgery. In ten studies comparing extended hemosiderin excision with only lesion resection were identified by searching the English-language literature. 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 5). They observed a variety of practice between centers and countries regarding the management of cavernous angioma located within eloquentregions. 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. 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 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 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 4).Īn 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.Ģ72 patients from 19 centers (mean 13.6 ± 16.7 per center) from eight countries were included. However, cases of eloquent or multiple localization or widespread hemosiderin deposit in which a complete resection is challenging should undergo a specific preoperative work-up 3).
The five black dots in the left cerebral hemisphere on the T2* are also cavernomas and are not visible on the T2WI.īased on the currently available data in 2017, Dammann et al., concluded that if surgical treatment of cavernoma-related epilepsy is performed, the peri-lesional hemosiderin should be resected. T2* and susceptibility weighted imaging (SWI) markedly increase the sensitivity of MRI to detect small cavernomas. The lesions are almost completely black on the gradient echo due to blooming artefacts. Notice the popcorn appearance with peripheral rim of hemosiderin on the T2WI. T2WI and T2* gradient echo show multiple cavernomas. The T2-weighted image show a cavernous malformation as heterogeneous and “popcorn-like” with a mixed signal intensity core and a hypointense hemosiderin rim. The hypointensity can be delineated further in the gradient echo sequence T2* images due to hemosiderin deposition in and around the cavernous malformation 1) 2).
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