Treatment of Cavernous Angioma Presenting with Epilepsy

You, Seung Hoon; Hong, Seung Chyul

Abstract

Cavernous angiomas (CAs) presenting with seizures have been regarded as a rather benign condition, because anti-epileptic drugs can be used as primary measures. Because CAs are frequently associated with diffusion of hemosiderin pigment into the surrounding brain tissue, there needs to be a special consideration in the management of CAs with seizures. The development of epilepsy surgery and neuro-imaging techniques, as well as the realization about the side effects of drugs are changing the concept of treatment of CAs. If the lesion is associated with intractable seizures, surgical treatment should be considered. Simple lesionectomy would relieve seizures significantly, but not always completely. The concept of epilepsy surgery needs to be recruited in such intractable cases, especially the lesion is located in the seizure-prone temporal lobe. Lesions located at or close to the eloquent areas can nowadays be removed safely by invasive and non-invasive functional mapping. Even though the seizures are not intractable, surgical resection can cure the rare seizures if the lesions are accessible. Careful assessment using comprehensive investigations on seizure itself, location of the lesion, and functional evaluation can cure the large proportion of patients suffering from seizures with CAs.