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Grigoryan Yu.A.

Federal Center of Medicine and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia

Sitnikov A.R.

Federal Center of Medicine and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia

Grigoryan G.Yu.

Federal Center of Medicine and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia

Timoshenkov A.V.

Federal Center of Treatment and Rehabilitation, Moscow, Russia

Mishnyakova L.P.

Federal Center of Treatment and Rehabilitation, Moscow, Russia

Surgical treatment of epilepsy in patients with mediobasal temporal cavernous malformations

Authors:

Grigoryan Yu.A., Sitnikov A.R., Grigoryan G.Yu., Timoshenkov A.V., Mishnyakova L.P.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2018;82(4): 45‑56

DOI: 10.17116/neiro201882445

Read: 4173 times

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Table of contents

SURGICAL TREATMENT OF EPILEPSY IN PATIENTS WITH MEDIOBASAL TEMPORAL CAVERNOUS MALFORMATIONS
SURGICAL TREATMENT OF EPILEPSY IN PATIENTS WITH MEDIOBASAL TEMPORAL CAVERNOUS MALFORMATIONS

To cite this article:

Grigoryan YuA, Sitnikov AR, Grigoryan GYu, Timoshenkov AV, Mishnyakova LP. Surgical treatment of epilepsy in patients with mediobasal temporal cavernous malformations. Burdenko's Journal of Neurosurgery. 2018;82(4):45‑56. (In Russ., In Engl.)
https://doi.org/10.17116/neiro201882445

Подписка 2025 Журнал «Вопросы нейрохирургии» имени Н.Н. Бурденко (Burdenko's Journal of Neurosurgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
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Abstract:

Objective — epilepsy is a frequent clinical manifestation of cavernous malformations (CMs) of the mediobasal temporal region (MBTR). Surgical removal of CMs is an excellent technique for treating associated epilepsy and may range from pure lesionectomy to tailored resection of the temporal lobe. Purpose. The study purpose was to determine the optimal surgical management for epilepsy in patients with CMs of the MBTR. Material and methods. We retrospectively analyzed the clinical data, neuroimaging findings, surgical techniques, and surgical outcomes in 11 patients with epilepsy and CMs of the MBTR. All patients underwent video-electroencephalography, magnetic resonance imaging, and computed tomography in the pre- and postoperative periods. Nine patients underwent preoperative implantation of foramen ovale electrodes. In all cases, surgery was accompanied by electrocorticography (ECoG). Results. CMs were located in the anterior MBTR in 7 cases, anterior and middle thirds of the MBTR in 1 case, middle third in 2 cases, and middle and posterior thirds in 1 case. In 8 patients, preoperative monitoring revealed a seizure onset area in the MBTR. These patients underwent cavernomectomy with ECoG-guided resection of the hemosiderin ring and adjacent tissue using the pterional (4 cases) or supracerebellar transtentorial approach (4). In 3 cases, anterior temporal lobectomy with cavernomectomy was additionally used due to spreading of pathological activity to the lateral temporal neocortex. Seizure control after surgery was excellent in 7 patients (class 1 ILAE) and good in 4 (class 2 ILAE). Conclusions. Surgery in patients with epilepsy caused by CMs of the MBTR should be performed based on non-invasive and invasive presurgical evaluation. If the seizure onset area is located in the MBTR, lesionectomy with ECoG-guided resection of the adjacent temporal cortical areas can be performed using the pterional or supracerebellar transtentorial approach. Lateral spread of epileptic activity requires cavernomectomy and anterior temporal lobectomy.

Keywords:

epilepsy
cavernous malformation
temporal lobe
mediobasal temporal region
electrocorticography
supracerebellar transtentorial approach

Authors:

Grigoryan Yu.A.

Federal Center of Medicine and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia

Sitnikov A.R.

Federal Center of Medicine and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia

Grigoryan G.Yu.

Federal Center of Medicine and Rehabilitation of the Ministry of Health of the Russian Federation, Moscow, Russia

Timoshenkov A.V.

Federal Center of Treatment and Rehabilitation, Moscow, Russia

Mishnyakova L.P.

Federal Center of Treatment and Rehabilitation, Moscow, Russia

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