Epileptogenicity of a patient with the association of medullary venous malformation and cavernous malformation

We present a surgical case of a 53-year-old man with lesion-related epilepsy associated with medullary venous malformation (MVM) and cavernous malformation (CM) in the right frontal lobe. He had frequent secondary generalized seizures since developing a MVM-related intracerebral hemorrhage in the right frontal lobe at the age of 44. Intraoperative electrocorticography demonstrated frequent paroxysmal activities on the yellowish cortex above the CM. Anterior frontal lobectomy including the irritative cortex, CM, MVM and its tributaries was performed. The patient became seizure free after surgery. Pathologically, the irritative cortex above the CM had hemosiderin deposits and astrogliosis. The CM was surrounded by dilated veins of various sizes, indicating MVM, which confirmed the radiological findings of so-called caput medusae. Epileptogenicity in patients with CM and MVM is thought to be due to repeated hemorrhage from the CM. Surgical strategy is discussed.