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7. Surgical resection of cavernous angioma located within eloquent brain areas: International survey of the practical management among 19 specialized centers

Author

Zanello, M, Meyer, B, Still, M, Goodden, J, Colle, H, Schichor, C, Bello, L, Wager, M, Smits, A, Rydenhag, B, Tate, M, Metellus, P, Hamer, P, Spena, G, Capelle, L, Mandonnet, E, Robles, S, Sarubbo, S, Martino Gonzalez, J, Fontaine, D, Reyns, N, Krieg, S, Huberfeld, G, Wostrack, M, Colle, D, Robert, E, Noens, B, Muller, P, Yusupov, N, Rossi, M, Conti Nibali, M, Papagno, C, Visser, V, Baaijen, H, Galbarritu, L, Chioffi, F, Bucheli, C, Roux, A, Dezamis, E, Duffau, H, Pallud, J, Zanello M., Meyer B., Still M., Goodden J. R., Colle H., Schichor C., Bello L., Wager M., Smits A., Rydenhag B., Tate M., Metellus P., Hamer P. D. W., Spena G., Capelle L., Mandonnet E., Robles S. G., Sarubbo S., Martino Gonzalez J., Fontaine D., Reyns N., Krieg S. M., Huberfeld G., Wostrack M., Colle D., Robert E., Noens B., Muller P., Yusupov N., Rossi M., Conti Nibali M., Papagno C., Visser V., Baaijen H., Galbarritu L., Chioffi F., Bucheli C., Roux A., Dezamis E., Duffau H., Pallud J., Zanello, M, Meyer, B, Still, M, Goodden, J, Colle, H, Schichor, C, Bello, L, Wager, M, Smits, A, Rydenhag, B, Tate, M, Metellus, P, Hamer, P, Spena, G, Capelle, L, Mandonnet, E, Robles, S, Sarubbo, S, Martino Gonzalez, J, Fontaine, D, Reyns, N, Krieg, S, Huberfeld, G, Wostrack, M, Colle, D, Robert, E, Noens, B, Muller, P, Yusupov, N, Rossi, M, Conti Nibali, M, Papagno, C, Visser, V, Baaijen, H, Galbarritu, L, Chioffi, F, Bucheli, C, Roux, A, Dezamis, E, Duffau, H, Pallud, J, Zanello M., Meyer B., Still M., Goodden J. R., Colle H., Schichor C., Bello L., Wager M., Smits A., Rydenhag B., Tate M., Metellus P., Hamer P. D. W., Spena G., Capelle L., Mandonnet E., Robles S. G., Sarubbo S., Martino Gonzalez J., Fontaine D., Reyns N., Krieg S. M., Huberfeld G., Wostrack M., Colle D., Robert E., Noens B., Muller P., Yusupov N., Rossi M., Conti Nibali M., Papagno C., Visser V., Baaijen H., Galbarritu L., Chioffi F., Bucheli C., Roux A., Dezamis E., Duffau H., and Pallud J.

Abstract

Purpose: The practical management of cavernous angioma located within eloquent brain area before, during and after surgical resection is poorly documented. We assessed the practical pre-operative, intra-operative, and post-operative management of cavernous angioma located within eloquent brain area. Method: An online survey composed of 61 items was sent to 26 centers to establish a multicenter international retrospective cohort of adult patients who underwent a surgical resection as the first-line treatment of a supratentorial cavernous angioma located within or close to eloquent brain area. Results: 272 patients from 19 centers (mean 13.6 ± 16.7 per center) from eight countries were included. The pre-operative management varied significantly between centers and countries regarding the pre-operative functional assessment, the pre-operative epileptological assessment, the first given antiepileptic drug, and the time to surgery. The intra-operative environment varied significantly between centers and countries regarding the use of imaging systems, the use of functional mapping with direct electrostimulations, the extent of resection of the hemosiderin rim, the realization of a post-operative functional assessment, and the time to post-operative functional assessment. The present survey found a post-operative improvement, as compared to pre-operative evaluations, of the functional status, the ability to work, and the seizure control. Conclusions: We observed a variety of practice between centers and countries regarding the management of cavernous angioma located within eloquent regions. Multicentric prospective studies are required to solve relevant questions regarding the management of cavernous angioma-related seizures, the timing of surgery, and the optimal extent of hemosiderin rim resection.

Published
2019

8. Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas

Author

Zanello, M, Goodden, J, Colle, H, Wager, M, Hamer, P, Smits, A, Bello, L, Tate, M, Spena, G, Bresson, D, Capelle, L, Robles, S, Sarubbo, S, Rydenhag, B, Martino, J, Meyer, B, Fontaine, D, Reyns, N, Schichor, C, Metellus, P, Colle, D, Robert, E, Noens, B, Muller, P, Rossi, M, Nibali, M, Papagno, C, Galbarritu, L, De Gopegui, E, Chioffi, F, Bucheli, C, Krieg, S, Wostrack, M, Yusupov, N, Visser, V, Baaijen, J, Roux, A, Dezamis, E, Mandonnet, E, Corns, R, Duffau, H, Pallud, J, Zanello M., Goodden J. R., Colle H., Wager M., Hamer P. C. D. W., Smits A., Bello L., Tate M., Spena G., Bresson D., Capelle L., Robles S. G., Sarubbo S., Rydenhag B., Martino J., Meyer B., Fontaine D., Reyns N., Schichor C., Metellus P., Colle D., Robert E., Noens B., Muller P., Rossi M., Nibali M. C., Papagno C., Galbarritu L., De Gopegui E. R., Chioffi F., Bucheli C., Krieg S. M., Wostrack M., Yusupov N., Visser V., Baaijen J. C., Roux A., Dezamis E., Mandonnet E., Corns R., Duffau H., Pallud J., Zanello, M, Goodden, J, Colle, H, Wager, M, Hamer, P, Smits, A, Bello, L, Tate, M, Spena, G, Bresson, D, Capelle, L, Robles, S, Sarubbo, S, Rydenhag, B, Martino, J, Meyer, B, Fontaine, D, Reyns, N, Schichor, C, Metellus, P, Colle, D, Robert, E, Noens, B, Muller, P, Rossi, M, Nibali, M, Papagno, C, Galbarritu, L, De Gopegui, E, Chioffi, F, Bucheli, C, Krieg, S, Wostrack, M, Yusupov, N, Visser, V, Baaijen, J, Roux, A, Dezamis, E, Mandonnet, E, Corns, R, Duffau, H, Pallud, J, Zanello M., Goodden J. R., Colle H., Wager M., Hamer P. C. D. W., Smits A., Bello L., Tate M., Spena G., Bresson D., Capelle L., Robles S. G., Sarubbo S., Rydenhag B., Martino J., Meyer B., Fontaine D., Reyns N., Schichor C., Metellus P., Colle D., Robert E., Noens B., Muller P., Rossi M., Nibali M. C., Papagno C., Galbarritu L., De Gopegui E. R., Chioffi F., Bucheli C., Krieg S. M., Wostrack M., Yusupov N., Visser V., Baaijen J. C., Roux A., Dezamis E., Mandonnet E., Corns R., Duffau H., and Pallud J.

Abstract

BACKGROUND: The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area. OBJECTIVE: To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery. METHODS: Multicenter international retrospective cohort analysis of adult patients benefitting from a functional-based surgical resection with intraoperative functional brain mapping for a supratentorial CA within or close to eloquent brain areas. RESULTS: A total of 109 patients (66.1% women; mean age 38.4 ± 12.5 yr), were studied. Age >38 yr (odds ratio [OR], 7.33; 95% confidence interval [CI], 1.53-35.19; P =. 013) and time to surgery > 12 mo (OR, 18.21; 95% CI, 1.11-296.55; P =. 042) are independent predictors of uncontrolled seizures at the time of surgery. Focal deficit (OR, 10.25; 95% CI, 3.16-33.28; P <. 001) is an independent predictor of inability to work at the time of surgery. History of epileptic seizures at the time of surgery (OR, 7.61; 95% CI, 1.67-85.42; P =. 003) and partial resection of the CA and/or of the hemosiderin rim (OR, 12.02; 95% CI, 3.01-48.13; P <. 001) are independent predictors of uncontrolled seizures postoperatively. Inability to work at the time of surgery (OR, 19.54; 95% CI, 1.90-425.48; P =. 050), Karnofsky Performance Status ≤ 70 (OR, 51.20; 95% CI, 1.20-2175.37; P =. 039), uncontrolled seizures postoperatively (OR, 105.33; 95% CI, 4.32-2566.27; P =. 004), and worsening of cognitive functions postoperatively (OR, 13.71; 95% CI, 1.06-176.66; P =. 045) are independent predictors of inability to work postoperatively. CONCLUSION: The functional-based resection using intraoperative functional brain mapping allows safe resection of CA and the peripheral hemosiderin rim located within or close to eloquent brain areas.

Published
2019

12. Congenital apocrine tumour: a rare scalp tumour.

Author

Goodden JR, Marven SS, Cohen M, de Ville McMullan PJ, and Smith MF

Subjects
Female, Head and Neck Neoplasms pathology, Head and Neck Neoplasms surgery, Humans, Infant, Newborn, Skin Neoplasms pathology, Skin Neoplasms surgery, Sweat Gland Neoplasms pathology, Sweat Gland Neoplasms surgery, Apocrine Glands, Head and Neck Neoplasms congenital, Scalp, Skin Neoplasms congenital, Sweat Gland Neoplasms congenital
Abstract

We report a rare congenital scalp tumour with histological diagnosis of a congenital apocrine adenoma with features of a tubular adenoma. Following cranial CT and MRI, the tumour was serially excised. The macroscopic and microscopic appearances and management are discussed. To our knowledge, such a case has not been previously reported.

Published
2008
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