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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

Forest plot of seizure outcomes comparing hemosiderin (-) group and hemosiderin (+) group.hemosiderin (-), with hemosiderin excision; hemosiderin (+), without hemosiderin excision; CI, confidence interval.
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pone.0136619.g002: Forest plot of seizure outcomes comparing hemosiderin (-) group and hemosiderin (+) group.hemosiderin (-), with hemosiderin excision; hemosiderin (+), without hemosiderin excision; CI, confidence interval.

Mentions: Thirteen studies with a total of 594 patients reported the seizure outcomes after CCM surgeries (234 of 316 obtained Engel ClassI in the hemosiderin (-) group versus 189 of 278 in the hemosiderin (+) group). The seizure outcome was statistically significantly improved in the patients who underwent extended excision of the surrounding hemosiderin (OR, 0.62; 95% CI: 0.42–0.91; P = 0.01; I2 = 28%; Fig 2). Sensitivity analysis showed that the results of the association between hemosiderin excision and seizure outcome were robust, which demonstrated that no significant heterogeneity existed across the studies. (Fig 3)


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)

Forest plot of seizure outcomes comparing hemosiderin (-) group and hemosiderin (+) group.hemosiderin (-), with hemosiderin excision; hemosiderin (+), without hemosiderin excision; CI, confidence interval.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0136619.g002: Forest plot of seizure outcomes comparing hemosiderin (-) group and hemosiderin (+) group.hemosiderin (-), with hemosiderin excision; hemosiderin (+), without hemosiderin excision; CI, confidence interval.
Mentions: Thirteen studies with a total of 594 patients reported the seizure outcomes after CCM surgeries (234 of 316 obtained Engel ClassI in the hemosiderin (-) group versus 189 of 278 in the hemosiderin (+) group). The seizure outcome was statistically significantly improved in the patients who underwent extended excision of the surrounding hemosiderin (OR, 0.62; 95% CI: 0.42–0.91; P = 0.01; I2 = 28%; Fig 2). Sensitivity analysis showed that the results of the association between hemosiderin excision and seizure outcome were robust, which demonstrated that no significant heterogeneity existed across the studies. (Fig 3)

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