Aneurysmal Clipping with Cortical Resection May Lead to a Favorable Outcome in Patients with Epilepsy Due to Unruptured Aneurysms
Abstract number :
2.197
Submission category :
Year :
2000
Submission ID :
2792
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Joseph I Sirven, Kathryn A Hirschorn, Jennifer J Bortz, Kent D Nelson, Geoffrey P Fletcher, Richard S Zimmerman, Mayo Clinic, Scottsdale, AZ.
RATIONALE: Unruptured cerebral aneurysms may be associated with seizures. Little is known about the relationship of aneurysms and seizures. Information is lacking whether resection of adjacent cortex at the time of aneurysm clipping would increase the likelihood of becoming seizure free. METHODS: All patient charts (N=7,000) from January 1996 to May 2000 with a diagnosis of seizures and/or unruptured aneurysm were reviewed for demographic and clinical data. Two neuroradiologists reviewed MRI, MRA and cerebral angiograms for aneurysm characteristics. Patients with unruptured aneurysms and seizures were compared to those with unruptured aneurysms without seizures for distinguishing characteristics. ANOVA and student's t-test were used for comparison. RESULTS: 105 patients (33 males/72 females; mean age 64 years, range 31-87 yrs) had 135 unruptured cerebral aneurysms . Thirteen patients (12%)with seizures associated with their lesions were identified. Patients with seizures had larger aneurysms (mean 11.2mm, range 5-20 mm) versus 5.8 mm(range 2-15mm) for non seizure patients (p<.05). All patients with seizures had a perianeurysmal hyperintense T2 signal on MRI versus none of the non-seizure patients (p<.001). Location and shape of aneurysm did not differ between groups, however the majority of seizure patients (8/13, 62%)had temporal lobe involvement. No patients with seizures had hippocampal sclerosis. Of seven patients who underwent surgery for aneurysmal clipping and seizure control, three had additional focal cortical resection guided by electrocorticography performed with clipping. All three patients with clipping and focal resection became seizure free while only 2 of the 4 became seizure free with clipping alone. Pathology revealed gliosis in the perianeurysmal tissue in all three patients. CONCLUSIONS: Patients with seizures from unruptured aneurysms had larger lesions and were invariably associated with T2 perianeurysmal hyperintense signal on MRI. When feasible, these patients with abnormal signal changes may benefit from cortical resection at the time of aneurysm clipping.