Cavernous malformations are known as essentially benign and silent disease. However, they become symptomatic with hemorrhage, seizure or neurological signs. In the cases with supratentorial lesions, seizures are so often intractable and resistant to anticonvulsants. We have experienced 25 cases with such intractable seizures and treated with radiosurgery. There are 13 males and 12 females, ages ranging from 13 to 49 (mean: 31.2 years). Seizure patterns are classified as generalized in 12, complex partial in 6, simple partial in 6, simple partial plus generalized in 1. Most of the lesions are located either in frontal or temporal lobe. At radiosurgery, cavernous malformations, with a mean diameter of 15.9 mm were treated with the maximum and marginal dose of 31.9 and 17.5 Gy respectively. In the mean follow-up period of 45.6 months, MRI showed CR in 1, PR in 9, MR in 2 and NC in 13, indicating the response rate 10/25 (40%). In contrast, the response of seizures are Engel Class I in 9, Class II in 5, Class III in 5 and Class IV in 6, indicating 9/25 (36%) of seizure-free and excellent control 14/25 (56%). Perifocal edema occurred often, but rarely symptomatic. In conclusion, radiosurgery demonstrated a moderate seizure control, but not perfect. The lesionectomy alone with radiosurgery does not always solve the problem, and precise localization of seizure discharge should be searched.
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