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The Role of Hemosiderin Excision in Seizure Outcome in Cerebral Cavernous Malformation Surgery: A Systematic Review and Meta-Analysis.

Ruan D, Yu XB, Shrestha S, Wang L, Chen G - PLoS ONE (2015)

Bottom Line: Seizure outcome was significantly improved in the patients who underwent an extended excision of the surrounding hemosiderin (OR, 0.62; 95% CI: 0.42-0.91; P = 0.01).In subgroup analysis, studies from Asia (OR, 0.42; 95% CI: 0.25-0.71; P = 0.001), male-majority (female ratio < 50%) studies (OR, 0.56; 95% CI: 0.33-0.96; P = 0.04), low occurrence rate of multiple CCMs (OR, 0.37; 95% CI: 0.20-0.71; P = 0.003), cohort studies (OR, 0.44; 95% CI: 0.28-0.68; P = 0.78), longer duration of seizure symptoms (> 1 year) before surgery (OR, 0.43; 95% CI: 0.22-0.84; P = 0.01), lesion diameter > 2 cm (OR, 0.41; 95% CI: 0.19-0.87; P = 0.02) and short-term (< 3 years) follow-up (OR, 0.48; 95% CI: 0.29-0.80; P = 0.005) tended to correlate with a significantly favorable outcome.However, further well-designed prospective multiple-center RCT studies are still needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, the People's Republic of China.

ABSTRACT

Background and purpose: Whether the excision of hemosiderin surrounding cerebral cavernous malformations (CCMs) is necessary to achieve a seizure-free result has been the subject of debate. Here, we report a systematic review of related literature up to Jan 1, 2015 including 594 patients to assess the effect of hemosiderin excision on seizure outcome in patients with CCMs by meta-analysis.

Methods: Ten studies comparing extended hemosiderin excision with only lesion resection were identified by searching the English-language literature. Meta-analyses, subgroup analyses and sensitivity analysis were conducted to determine the association between hemosiderin excision and seizure outcome after surgery.

Results: Seizure outcome was significantly improved in the patients who underwent an extended excision of the surrounding hemosiderin (OR, 0.62; 95% CI: 0.42-0.91; P = 0.01). In subgroup analysis, studies from Asia (OR, 0.42; 95% CI: 0.25-0.71; P = 0.001), male-majority (female ratio < 50%) studies (OR, 0.56; 95% CI: 0.33-0.96; P = 0.04), low occurrence rate of multiple CCMs (OR, 0.37; 95% CI: 0.20-0.71; P = 0.003), cohort studies (OR, 0.44; 95% CI: 0.28-0.68; P = 0.78), longer duration of seizure symptoms (> 1 year) before surgery (OR, 0.43; 95% CI: 0.22-0.84; P = 0.01), lesion diameter > 2 cm (OR, 0.41; 95% CI: 0.19-0.87; P = 0.02) and short-term (< 3 years) follow-up (OR, 0.48; 95% CI: 0.29-0.80; P = 0.005) tended to correlate with a significantly favorable outcome.

Conclusion: Patients who underwent extended surrounding hemosiderin excision could exhibit significantly improved seizure outcomes compared to patients without hemosiderin excision. However, further well-designed prospective multiple-center RCT studies are still needed.

No MeSH data available.


Related in: MedlinePlus

Flow chart of literature selection.
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pone.0136619.g001: Flow chart of literature selection.

Mentions: Fig 1 details the selection criteria we used. The inclusion criteria were as follows: (1) series of at least 10 patients undergoing CCM surgery; (2) cohort or case-control studies comparing the extended hemosiderin excision with lesion resection only; (3) CCM patients with epilepsy or seizure symptoms before surgery; (4) seizure outcomes measured or calculated according to Engel Class; (5) explicitly reported numbers of patients who underwent or did not undergo hemosiderin excision; (6) duration of follow-up of at least 12 months; and (7) study quality score >4 on the Newcastle-Ottawa Scale (NOS) [22]. The exclusion criteria were as follows: (1) study did not provide sufficient extractable data on the patient number and follow-up outcome; (2) study was a system review or case report; (3) study did not compare the seizure outcomes of the excision group and control group; (4) study was not written in English; and (5) study with only the abstract available, or unpublished study. The quality of case-control or cohort studies was assessed by the NOS.


The Role of Hemosiderin Excision in Seizure Outcome in Cerebral Cavernous Malformation Surgery: A Systematic Review and Meta-Analysis.

Ruan D, Yu XB, Shrestha S, Wang L, Chen G - PLoS ONE (2015)

Flow chart of literature selection.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4548944&req=5

pone.0136619.g001: Flow chart of literature selection.
Mentions: Fig 1 details the selection criteria we used. The inclusion criteria were as follows: (1) series of at least 10 patients undergoing CCM surgery; (2) cohort or case-control studies comparing the extended hemosiderin excision with lesion resection only; (3) CCM patients with epilepsy or seizure symptoms before surgery; (4) seizure outcomes measured or calculated according to Engel Class; (5) explicitly reported numbers of patients who underwent or did not undergo hemosiderin excision; (6) duration of follow-up of at least 12 months; and (7) study quality score >4 on the Newcastle-Ottawa Scale (NOS) [22]. The exclusion criteria were as follows: (1) study did not provide sufficient extractable data on the patient number and follow-up outcome; (2) study was a system review or case report; (3) study did not compare the seizure outcomes of the excision group and control group; (4) study was not written in English; and (5) study with only the abstract available, or unpublished study. The quality of case-control or cohort studies was assessed by the NOS.

Bottom Line: Seizure outcome was significantly improved in the patients who underwent an extended excision of the surrounding hemosiderin (OR, 0.62; 95% CI: 0.42-0.91; P = 0.01).In subgroup analysis, studies from Asia (OR, 0.42; 95% CI: 0.25-0.71; P = 0.001), male-majority (female ratio < 50%) studies (OR, 0.56; 95% CI: 0.33-0.96; P = 0.04), low occurrence rate of multiple CCMs (OR, 0.37; 95% CI: 0.20-0.71; P = 0.003), cohort studies (OR, 0.44; 95% CI: 0.28-0.68; P = 0.78), longer duration of seizure symptoms (> 1 year) before surgery (OR, 0.43; 95% CI: 0.22-0.84; P = 0.01), lesion diameter > 2 cm (OR, 0.41; 95% CI: 0.19-0.87; P = 0.02) and short-term (< 3 years) follow-up (OR, 0.48; 95% CI: 0.29-0.80; P = 0.005) tended to correlate with a significantly favorable outcome.However, further well-designed prospective multiple-center RCT studies are still needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, the People's Republic of China.

ABSTRACT

Background and purpose: Whether the excision of hemosiderin surrounding cerebral cavernous malformations (CCMs) is necessary to achieve a seizure-free result has been the subject of debate. Here, we report a systematic review of related literature up to Jan 1, 2015 including 594 patients to assess the effect of hemosiderin excision on seizure outcome in patients with CCMs by meta-analysis.

Methods: Ten studies comparing extended hemosiderin excision with only lesion resection were identified by searching the English-language literature. Meta-analyses, subgroup analyses and sensitivity analysis were conducted to determine the association between hemosiderin excision and seizure outcome after surgery.

Results: Seizure outcome was significantly improved in the patients who underwent an extended excision of the surrounding hemosiderin (OR, 0.62; 95% CI: 0.42-0.91; P = 0.01). In subgroup analysis, studies from Asia (OR, 0.42; 95% CI: 0.25-0.71; P = 0.001), male-majority (female ratio < 50%) studies (OR, 0.56; 95% CI: 0.33-0.96; P = 0.04), low occurrence rate of multiple CCMs (OR, 0.37; 95% CI: 0.20-0.71; P = 0.003), cohort studies (OR, 0.44; 95% CI: 0.28-0.68; P = 0.78), longer duration of seizure symptoms (> 1 year) before surgery (OR, 0.43; 95% CI: 0.22-0.84; P = 0.01), lesion diameter > 2 cm (OR, 0.41; 95% CI: 0.19-0.87; P = 0.02) and short-term (< 3 years) follow-up (OR, 0.48; 95% CI: 0.29-0.80; P = 0.005) tended to correlate with a significantly favorable outcome.

Conclusion: Patients who underwent extended surrounding hemosiderin excision could exhibit significantly improved seizure outcomes compared to patients without hemosiderin excision. However, further well-designed prospective multiple-center RCT studies are still needed.

No MeSH data available.


Related in: MedlinePlus