Tetsuya Tsukahara, Giuseppe Esposito, Hans-Jakob Steiger, Gabriel J.E. Rinkel and Luca Regli (eds.)Acta Neurochirurgica SupplementTrends in Neurovascular Interventions201410.1007/978-3-319-02411-0_19

Epilepsy and Headache After Resection of Cerebral Arteriovenous Malformations

Hans-Jakob Steiger¹, Nima Etminan¹ and Daniel Hänggi¹

(1)

Department of Neurosurgery, Heinrich-Heine-Universität, Moorenstr. 5, Geb. 13.71, Düsseldorf, D-40225, Germany

Hans-Jakob Steiger

Email: steiger@uni-duesseldorf.de

Abstract

The therapeutic benefits of microsurgery for cerebral arteriovenous malformations (AVM) with regard to headache and epilepsy are not well known. The objective of the present review is to discuss the available evidence and our own experience, which showed that two-thirds of the patients with preoperative epilepsy experienced long-term improvement, one-sixth no significant change, and an equal number worsening. New seizures occurred postoperatively in 18 % of the patients presenting with hemorrhage. Regarding headache, 40 % of patients with preoperative chronic headache reported improvement and 50 % described no change, whereas 10 % suffered from deterioration. With regard to epilepsy, the available literature suggests, that an epileptological approach with preoperative identification of the seizure focus and corresponding resection might improve the results. With regard to headache outcome, almost no information is available in the literature, suggesting that these complaints of the patients have so far not received the necessary attention. In conclusion, the long-term treatment results regarding chronic epilepsy and chronic headache need further study and optimization.

Keywords

Cerebral arteriovenous malformationQuality of lifeEpilepsyHeadache

Introduction

The therapeutic benefits of microsurgery for cerebral arteriovenous malformations (AVM) with regard to quality of life, headache and epilepsy are largely unknown [11]. Therefore, we tried to deduct some information from a homogenously managed population of 110 surgically treated patients with cerebral AVM who were operated on between November 1994 and June 2009. The details of the entire analysis, including quality of life, will be published elsewhere. The purpose of the actual presentation is to discuss the available literature in the light of our retrospective data and estimate of the real long-term benefit of surgery for epilepsy and headache associated with ruptured and unruptured AVM.

Data Derived from Our Own Experience

Descriptive data regarding epidemiological, socio-demographic and disease-related characteristics were extracted from the patient records. In the beginning of 2010 an attempt was made to contact all patients for a long-term follow-up with respect to epilepsy, neurological deficits, headaches, and, in particular, quality of life. The contacts were made by telephone and the information was gathered using a structured telephone interview. Information on epilepsy and headache prior to surgery was based on the information in the hospital records and not on the patients’ perspective at the time of follow-up. Exploratory statistics correlated the postoperative outcome data to potential influencing factors by univariate comparison. T-statistics were used to compare mean values of stratified groups and Fisher’s exact test for proportions.

Long-term follow-up data were available in approximately half of the treated patients. The average interval between AVM treatment and follow-up interview was 7 years. The profile of the sample available for follow-up corresponded well to the overall patient population with regard to initial neurological deficits and at the time of discharge, Spetzler-Martin grade, hemorrhagic manifestation etc., thereby excluding a significant selection bias in the sample available for the quality of life survey. Only the group with a reduced level of consciousness at the time of discharge was underrepresented in the cohort available for follow-up. Two-thirds of the patients were admitted after hemorrhage.

Preoperatively, 36 % of all patients had experienced at least one epileptic seizure and 25 % suffered of chronic headaches. At the time of the follow-up after an average of 7 years, 65 % of the follow-up cohort reported improvement of epilepsy (Engel class 1–2, free of disabling seizures or rare disabling seizures), 17 % reported no significant change and 18 % reported worsening. Another 18 % of patients in whom epilepsy was not known at the time of AVM treatment reported seizures during follow-up. All but one of these had been treated for their AVM after hemorrhage.

Regarding headache, 26 % of patients reported chronic headache at the time of admission. Upon long-term follow-up 39 % of these patients reported improvement, 54 % no change and 8 % worsening.

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