Surgery to remove a CCM may be an option to control seizures that do not respond to medicine. Surgery might also be an option to reduce the risk of future health problems the CCM may cause.
Seattle Children’s neurosurgeons have special expertise in removing CCMs and using the brain-mapping tools that make this surgery as safe as possible.
Deciding on surgery
We consider surgery for children with CCMs on a case-by-case basis. Each child is different, and it is important to carefully weigh the possible benefits and risks for your child.
Our neurosurgeons consider many factors, including these:
- Whether your child’s lesion is getting bigger
- Whether doctors believe your child’s CCM is at high risk of bleeding
- Whether your child has repeated seizures that are not controlled with medicines
- Whether doctors can tell which lesion is causing your child’s symptoms (if your child has more than 1 lesion)
- Whether the lesion is in a place that makes it more likely or less likely to bleed (or rebleed) if left alone
- Whether neurosurgeons can safely get to the lesion to remove it
- What the risks of surgery may be to nearby healthy tissue
Mapping brain function
Before surgery, we use advanced techniques, like MRI (magnetic resonance imaging) and fMRI (functional magnetic resonance imaging), to pinpoint important brain areas near the CCM. We use these methods to:
- Help decide whether to recommend surgery
- Tell which areas to avoid during surgery to reduce the risk of problems with talking, moving or other functions
During an fMRI scan, we ask your child to do something, like tap their finger, look at pictures, read or listen to words. This allows us to see which parts of the brain are being used during these tasks. The tasks we ask your child to do are tailored to their age and abilities.
If needed, our neurosurgeons perform surgery to place (implant) electrodes on the surface of your child’s brain for a few days to identify critical areas, a process called electric brain mapping (electrocorticography, ECoG). ECoG can also be used to look for clues to a child’s seizures. ECoG is also known as intracranial electroencephalography, or iEEG.
Sometimes the best way to protect language and motor functions is to wake your child up during the surgery to remove their lesions. The neurosurgeon uses a small electric current to briefly cause brain activity in specific areas. If this disrupts an important function, we know this function is controlled by this area and we should avoid it. This does not cause any pain for your child.
To remove a CCM, the neurosurgeon performs a surgery called craniotomy, using a microscope to see fine details of the lesion.
If neurosurgeons cannot safely reach the lesion with craniotomy, some treatment centers have tried radiosurgery. We do not use this method at Seattle Children’s because it has not proved to be a good way to cure CCMs or their symptoms and the radiation can lead to significant problems, such as neurologic deficits.
Care after surgery
After surgery for a CCM, many children leave the hospital within a few days and return to their normal life and activities within a few weeks. Some children are cured of their CCM and any related seizures or other symptoms with no neurological deficits.
Children who had neurological deficits before surgery may get back to the same level of function after surgery with rehabilitation services, like physical therapy, occupational therapy and speech and language therapy; some may improve their function even more.
Seattle Children’s provides a full range of care for children with CCMs, including rehabilitation for those who need it and long-term follow-up.