Intractable epilepsy associated with multiple cavernous malformations: case report.

Abstract

Epilepsy associated with cavernous malformations is often effectively controlled by lesionectomy alone. Detailed preoperative evaluation is necessary if the lesions are multiple and the seizures are medically intractable. We report on a patient with multiple cavernous malformations associated with medically intractable seizures who became seizure-free after a single gyrus resection. The importance of electroencephalography with video monitoring is emphasized. The patient was a 25-year-old man with a 10-year history of complex partial and generalized convulsions. Magnetic resonance imaging revealed more than 10 cavernous malformations. Video-electroencephalographic monitoring indicated that seizures originated from either the frontal or temporal lobe of the right hemisphere. Subdural electrodes were implanted, covering both frontal and both temporal lobes. The seizures originated in the right frontal lobe. The gyrus, including a calcified cavernous malformation, was removed, and multiple subpial transections of the surrounding cortices were performed. The patient has been free of seizures for 22 months after surgery. Medically intractable seizures associated with multiple cavernous angiomas can be controlled by a single resective procedure.