Treatment of drug-resistant epilepsy associated with temporal lobe cavernomas

Pharmacoresistance (drug-resistance) occurs in 40 % of cases of structural epilepsy associated with cavernous malformations. The surgical strategy in the treatment of such patients aims, on one hand, to eliminate the epileptogenic focus and achieve seizure control; on the other hand, to remove the cavernoma and eliminate the risk of recurrent hemorrhage. The following surgical options are identified: 1) removal of only the cavernous malformation; 2) microsurgical removal of the cavernoma with a perifocal area of hemosiderin and a zone of gliosis; 3) stereotactic radiosurgery method. In cases of temporal cavernoma, anterior medial temporal lobectomy is highlighted as an additional method of surgical treatment. This localization requires a special approach to the choice of surgical strategy depending on the location of the cavernoma in relation to the structures of the hippocampal complex, the presence of secondary epileptogenic foci and the duration of epilepsy.

Aim of the work – to analyze the current data on the examined topic, aspects of surgical treatment of patients with structural focal epilepsy associated with cavernomas, using the example of three clinical cases.

Clinical examples are presented based on data from three patients operated on at the Federal Center of Brain Research and Neurotechnologies of the Federal Medical Biological Agency (FMBA) of Russia between 2022 and 2023. A literature review was conducted on treatment options for this category of patients. Articles were searched on the scientific platforms PubMed, Cochrane Library, eLIBRARY. RU, and the Journal of Neurosurgery, using the following search terms: cavernous malformation, structural epilepsy, temporal focal epilepsy.

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