Long-term visual outcome after microsurgical removal of occipital lobe cavernomas

Clinical article

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Object

Cavernomas in the occipital lobe are relatively rare. Because of the proximity to the visual cortex and incoming subcortical tracts, microsurgical removal of occipital cavernomas may be associated with a risk of visual field defects. The goal of the study was to analyze long-term outcome after operative treatment of occipital cavernomas with special emphasis on visual outcome.

Methods

Of the 390 consecutive patients with cavernomas who were treated at Helsinki University Central Hospital between 1980 and 2011, 19 (5%) had occipital cavernomas. Sixteen patients (4%) were surgically treated and are included in this study. The median age was 39 years (range 3–59 years). Seven patients (56%) suffered from hemorrhage preoperatively, 5 (31%) presented with visual field deficits, 11 (69%) suffered from seizures, and 4 (25%) had multiple cavernomas. Surgery was indicated for progressive neurological deterioration. The median follow-up after surgery was 5.25 years (range 0.5–14 years).

Results

All patients underwent thorough neuroophthalmological assessment to determine visual outcome after surgery. Visual fields were classified as normal, mild homonymous visual field loss (not disturbing the patient, driving allowed), moderate homonymous visual field loss (disturbing the patient, driving prohibited), and severe visual field loss (total homonymous hemianopia or total homonymous quadrantanopia). At the last follow-up, 4 patients (25%) had normal visual fields, 6 (38%) had a mild visual field deficit, 1 (6%) complained of moderate visual field impairment, and 5 (31%) had severe homonymous visual field loss. Cavernomas seated deeper than 2 cm from the pial surface carried a 4.4-fold risk of postoperative visual field deficit relative to superficial ones (p = 0.034). Six (55%) of the 11 patients presenting with seizures were seizure-free postoperatively. Eleven (69%) of 16 patients had no disability during the long-term follow-up.

Conclusions

Surgical removal of occipital cavernomas may carry a significant risk of postoperative visual field deficit, and the risk is even higher for deeper lesions. Seizure outcome after removal of these cavernomas appeared to be worse than that after removal in other supratentorial locations. This should be taken into account during preoperative planning.

Abbreviation used in this paper:DRE = drug-resistant epilepsy.

Article Information

Address correspondence to: Juri Kivelev, M.D., Ph.D., Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland. email: juri.kivelev@hus.fi.

Please include this information when citing this paper: published online June 15, 2012; DOI: 10.3171/2012.5.JNS112102.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    An occipital cavernoma causing an acute extralesional hemorrhage. Left: Preoperative CT scan. Right: A T2-weighted MRI study obtained after lesionectomy.

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    Deep cavernomas in the region of the atrium, on the border of occipital and parietal lobes in a patient with multiple lesions. Postoperatively, the patient developed complete homonymous hemianopia. Left: Coronal T2-weighted MRI study. Right: Axial T2*-weighted gradient echo MRI study showing an occipital lesion and a small frontal lesion.

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    Tiny occipital cavernoma (arrow) causing repetitive seizures within the same day, indicating surgical removal. Perimetry tests after several weeks postoperatively showed new visual field deficits. Left: Axial T2-weighted MRI study. Right: Axial T2*-weighted gradient echo MRI study.

  • View in gallery

    Example of an absolute homonymous visual field deficit (Group 3) detected at the perimetry test. Right: Panel shows findings from the left eye.

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