La epilepsia asociada a múltiples lesiones cerebrales requiere una evaluación prequirúrgica detallada. Se describe el caso de una paciente con 9 malformaciones cavernomatosas asociadas a epilepsia refractaria al tratamiento médico. Se destaca la importancia de un detallado análisis neurorradiológico y electroencefalográfico.
Caso clínicoSe trata de una paciente diestra de 56 años con una historia previa de epilepsia refractaria con crisis parciales complejas y secundariamente generalizadas de 26 años de evolución. Un estudio no invasivo con video electroencefalografía demostró una zona epileptogénica temporal anterior izquierda. El estudio detallado de imagen de RM no reveló alteraciones en la formación hipocámpica del mismo lado. Se realizó una lesionectomía extendida de 2 cavernomas adyacentes. La paciente ha permanecido sin crisis durante 24 meses posteriores a la cirugía.
ConclusionesLas crisis epilépticas fármaco-resistentes asociadas a cavernomas múltiples pueden ser diagnosticadas mediante estudios prequirúrgicos no invasivos y tratadas mediante procedimientos resectivos únicos.
Epilepsy associated with multiple lesions requires a detailed preoperative evaluation. We report on a patient with 9 cavernous malformations associated with medically intractable seizures who became seizure free after a selective resection of two adjacent cavernous resection. The importance of a detailed neuroradiological and electroencephalographic analysis is stressed.
Case reportThe patient was a right-handed 56-year-old woman with a 26-year history of complex partial and secondarily generalized seizures. A non-invasive video EEG monitoring revealed the epileptogenic zone was temporal anterior on the left. A detailed MRI-analysis showed an intact hippocampal formation. An extended lesionectomy of 2 adjacent cavernomas was done. The patient has been free of seizures for 24 months after surgery.
ConclusionsMedically intractable seizures associated with multiple cavernous malformations can be diagnosed by non-invasive preoperative monitoring and controlled by single resective procedures.
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