OBJECTIVE: Stereotactic radiosurgery (SRS) has been proposed as an alternative to resection for epilepsy control in patients with cerebral cavernous malformations (CCM) located in critical areas. METHODS: This multicentric, retrospective study evaluated seizure control in patients with a solitary CCM and a history of at least one seizure prior to SRS. RESULTS: 109 patients (median age at diagnosis 28.9 years, interquartile range (IQR) 16.4 years] were included. Prior to SRS, 2 (1.8%) were seizure-free without medication, 35 (32.1%) were seizure-free with antiseizure medications (ASM), 17 (15.6%) experienced an improvement of at least 50% in seizure frequency/intensity with ASM, and 55 (50.5%) experienced an improvement of less than 50% in seizure frequency/intensity with ASM. At a median follow-up of 3.5 years post-SRS (IQR: 4.9), 52 (47.7%) patients were Engel class I, 13 (11.9%) class II, 17 (15.6%) class III, 22 (20.2%) class IVA or IVB and 5 (4.6%) class IVC. For the 72 patients who had seizures despite medication prior to SRS, a delay > 1.5 years between epilepsy presentation and SRS decreased the probability to become seizure-free, HR 0.25 (95% CI 0.09-0.66), p = 0.006. The probability of achieving Engel I at the last follow-up was 23.6 (95% CI 12.7-33.1) and 31.3% (95% CI 19.3-50.8) at 2 and 5 years respectively. 27 patients were considered as having drug-resistant epilepsy. At a median follow-up of 3.1 years (IQR: 4.7), 6 (22.2%) of them were Engel I, 3 (11.1%) Engel II, 7 (25.9%) Engel III, 8 (29.6%) Engel IVA or IVB and 3 (11.1%) Engel IVC. INTERPRETATION: 47.7% of patients managed with SRS for solitary CCM presenting with seizures achieved Engel class I at the last follow-up.

Department of Neurological Surgery Hospices Civils de Lyon Lyon France

Department of Neurological Surgery University of Virginia 1215 Lee St Charlottesville VA 22908 USA

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery NYU Langone New York City NY USA

Department of Neurosurgery Scientific Institute for Research Hospitalization and Healthcare IRCCS Humanitas Research Hospital Milan Italy

Department of Neurosurgery University of Alberta Edmonton Alberta Canada

Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt

Department of Radiosurgery Rúber Internacional Hospital Madrid Spain

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Departments of Clinical Oncology Ain Shams University Cairo Egypt

Departments of Neurosurgery Ain Shams University Cairo Egypt

Departments of Neurosurgery Postgraduate Institute of Medical Education and Research Chandigarh India

Departments of Radiation Therapy Postgraduate Institute of Medical Education and Research Chandigarh India

Division of Neurosurgery Université de Sherbrooke Centre de Recherche du CHUS Sherbrooke QC Canada

Division of RadiationOncology Department of Oncology University of Alberta Edmonton Alberta Canada

Dominican Gamma Knife Center and Radiology Department CEDIMAT Santo Domingo Dominican Republic

Extended Modular Program Faculty of Medecine Ain Shams University Cairo Egypt

Gamma Knife Center Cairo Nasser Institute Hospital Cairo Egypt

Gamma Knife Center Jewish Hospital Mayfield Clinic Cincinnati OH USA

Mediterraneo Hospital Neurosurgery Athens Greece

Neurosurgery Department Faculty of Medecine Benha University Qalubiya Egypt

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