Seizure predictors and control after microsurgical resection of supratentorial arteriovenous malformations in 440 patients

Dario J. Englot, William L. Young, Seunggu (Jude) Han, Charles E. McCulloch, Edward F. Chang, Michael T. Lawton

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

BACKGROUND:: Seizures are a common symptom of supratentorial arteriovenous malformations (AVMs), and uncontrolled epilepsy can considerably reduce patient quality of life. Potential risk factors for epilepsy in patients with AVMs are poorly understood, and the importance of achieving freedom from seizures in their surgical treatment remains underappreciated. OBJECTIVE:: To characterize risks factors for preoperative seizures and factors associated with postoperative freedom from seizures in patients with surgically resected supratentorial AVMs. METHODS:: We analyzed prospectively collected patient data for 440 patients who underwent microsurgical resection of supratentorial AVMs at our institution. RESULTS:: Among 440 patients with supratentorial AVMs, 130 (30%) experienced preoperative seizures, and 23 (18%) with seizures progressed to medically refractory epilepsy. Seizures were associated with a history of AVM hemorrhage (relative risk, 6.65; 95% confidence interval [CI], 3.81-11.6), male sex (relative risk, 2.07; 95% CI, 1.26-3.39), and frontotemporal lesion location (relative risk, 1.75; 95% CI, 1.05-2.93). After resection, 96% of patients had a modified Engel class I outcome, characterized by freedom from seizures (80%) or only 1 postoperative seizure (16%; mean follow-up, 20.7 ± 2.3 months). Comparable rates of postoperative seizures were seen in patients with (7%) or without (3%) preoperative seizures. AVMs with deep artery perforators were significantly associated with postoperative seizures (hazard ratio, 4.35; 95% CI, 1.61-11.7). CONCLUSION:: In the microsurgical treatment of supratentorial AVMs, hemorrhage, male sex, and frontotemporal location are associated with higher rates of preoperative seizures, whereas deep artery perforators are associated with postoperative seizures. Achieving freedom from seizure is an important goal that can be achieved in the surgical treatment of AVMs because epilepsy can significantly diminish patient quality of life.

Original languageEnglish (US)
Pages (from-to)572-579
Number of pages8
JournalNeurosurgery
Volume71
Issue number3
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

Fingerprint

Arteriovenous Malformations
Seizures
Epilepsy
Confidence Intervals
Arteries
Quality of Life
Hemorrhage

Keywords

  • Arteriovenous malformation
  • AVM
  • Epilepsy
  • Seizure
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Seizure predictors and control after microsurgical resection of supratentorial arteriovenous malformations in 440 patients. / Englot, Dario J.; Young, William L.; Han, Seunggu (Jude); McCulloch, Charles E.; Chang, Edward F.; Lawton, Michael T.

In: Neurosurgery, Vol. 71, No. 3, 01.09.2012, p. 572-579.

Research output: Contribution to journalArticle

Englot, Dario J. ; Young, William L. ; Han, Seunggu (Jude) ; McCulloch, Charles E. ; Chang, Edward F. ; Lawton, Michael T. / Seizure predictors and control after microsurgical resection of supratentorial arteriovenous malformations in 440 patients. In: Neurosurgery. 2012 ; Vol. 71, No. 3. pp. 572-579.
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abstract = "BACKGROUND:: Seizures are a common symptom of supratentorial arteriovenous malformations (AVMs), and uncontrolled epilepsy can considerably reduce patient quality of life. Potential risk factors for epilepsy in patients with AVMs are poorly understood, and the importance of achieving freedom from seizures in their surgical treatment remains underappreciated. OBJECTIVE:: To characterize risks factors for preoperative seizures and factors associated with postoperative freedom from seizures in patients with surgically resected supratentorial AVMs. METHODS:: We analyzed prospectively collected patient data for 440 patients who underwent microsurgical resection of supratentorial AVMs at our institution. RESULTS:: Among 440 patients with supratentorial AVMs, 130 (30{\%}) experienced preoperative seizures, and 23 (18{\%}) with seizures progressed to medically refractory epilepsy. Seizures were associated with a history of AVM hemorrhage (relative risk, 6.65; 95{\%} confidence interval [CI], 3.81-11.6), male sex (relative risk, 2.07; 95{\%} CI, 1.26-3.39), and frontotemporal lesion location (relative risk, 1.75; 95{\%} CI, 1.05-2.93). After resection, 96{\%} of patients had a modified Engel class I outcome, characterized by freedom from seizures (80{\%}) or only 1 postoperative seizure (16{\%}; mean follow-up, 20.7 ± 2.3 months). Comparable rates of postoperative seizures were seen in patients with (7{\%}) or without (3{\%}) preoperative seizures. AVMs with deep artery perforators were significantly associated with postoperative seizures (hazard ratio, 4.35; 95{\%} CI, 1.61-11.7). CONCLUSION:: In the microsurgical treatment of supratentorial AVMs, hemorrhage, male sex, and frontotemporal location are associated with higher rates of preoperative seizures, whereas deep artery perforators are associated with postoperative seizures. Achieving freedom from seizure is an important goal that can be achieved in the surgical treatment of AVMs because epilepsy can significantly diminish patient quality of life.",
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T1 - Seizure predictors and control after microsurgical resection of supratentorial arteriovenous malformations in 440 patients

AU - Englot, Dario J.

AU - Young, William L.

AU - Han, Seunggu (Jude)

AU - McCulloch, Charles E.

AU - Chang, Edward F.

AU - Lawton, Michael T.

PY - 2012/9/1

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N2 - BACKGROUND:: Seizures are a common symptom of supratentorial arteriovenous malformations (AVMs), and uncontrolled epilepsy can considerably reduce patient quality of life. Potential risk factors for epilepsy in patients with AVMs are poorly understood, and the importance of achieving freedom from seizures in their surgical treatment remains underappreciated. OBJECTIVE:: To characterize risks factors for preoperative seizures and factors associated with postoperative freedom from seizures in patients with surgically resected supratentorial AVMs. METHODS:: We analyzed prospectively collected patient data for 440 patients who underwent microsurgical resection of supratentorial AVMs at our institution. RESULTS:: Among 440 patients with supratentorial AVMs, 130 (30%) experienced preoperative seizures, and 23 (18%) with seizures progressed to medically refractory epilepsy. Seizures were associated with a history of AVM hemorrhage (relative risk, 6.65; 95% confidence interval [CI], 3.81-11.6), male sex (relative risk, 2.07; 95% CI, 1.26-3.39), and frontotemporal lesion location (relative risk, 1.75; 95% CI, 1.05-2.93). After resection, 96% of patients had a modified Engel class I outcome, characterized by freedom from seizures (80%) or only 1 postoperative seizure (16%; mean follow-up, 20.7 ± 2.3 months). Comparable rates of postoperative seizures were seen in patients with (7%) or without (3%) preoperative seizures. AVMs with deep artery perforators were significantly associated with postoperative seizures (hazard ratio, 4.35; 95% CI, 1.61-11.7). CONCLUSION:: In the microsurgical treatment of supratentorial AVMs, hemorrhage, male sex, and frontotemporal location are associated with higher rates of preoperative seizures, whereas deep artery perforators are associated with postoperative seizures. Achieving freedom from seizure is an important goal that can be achieved in the surgical treatment of AVMs because epilepsy can significantly diminish patient quality of life.

AB - BACKGROUND:: Seizures are a common symptom of supratentorial arteriovenous malformations (AVMs), and uncontrolled epilepsy can considerably reduce patient quality of life. Potential risk factors for epilepsy in patients with AVMs are poorly understood, and the importance of achieving freedom from seizures in their surgical treatment remains underappreciated. OBJECTIVE:: To characterize risks factors for preoperative seizures and factors associated with postoperative freedom from seizures in patients with surgically resected supratentorial AVMs. METHODS:: We analyzed prospectively collected patient data for 440 patients who underwent microsurgical resection of supratentorial AVMs at our institution. RESULTS:: Among 440 patients with supratentorial AVMs, 130 (30%) experienced preoperative seizures, and 23 (18%) with seizures progressed to medically refractory epilepsy. Seizures were associated with a history of AVM hemorrhage (relative risk, 6.65; 95% confidence interval [CI], 3.81-11.6), male sex (relative risk, 2.07; 95% CI, 1.26-3.39), and frontotemporal lesion location (relative risk, 1.75; 95% CI, 1.05-2.93). After resection, 96% of patients had a modified Engel class I outcome, characterized by freedom from seizures (80%) or only 1 postoperative seizure (16%; mean follow-up, 20.7 ± 2.3 months). Comparable rates of postoperative seizures were seen in patients with (7%) or without (3%) preoperative seizures. AVMs with deep artery perforators were significantly associated with postoperative seizures (hazard ratio, 4.35; 95% CI, 1.61-11.7). CONCLUSION:: In the microsurgical treatment of supratentorial AVMs, hemorrhage, male sex, and frontotemporal location are associated with higher rates of preoperative seizures, whereas deep artery perforators are associated with postoperative seizures. Achieving freedom from seizure is an important goal that can be achieved in the surgical treatment of AVMs because epilepsy can significantly diminish patient quality of life.

KW - Arteriovenous malformation

KW - AVM

KW - Epilepsy

KW - Seizure

KW - Surgery

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