Clinical characteristics and surgical outcome of patients with temporal lobe tumors and epilepsy

Abstract

-This is a retrospective study of 21 surgically treated patients with temporal lobe tumors and epilepsy. Evaluation included clinical data, EEG findings, structural scans, pathological diagnosis and postsurgical follow-up. There were 9 cases of ganglioglioma, 5 pilocytic astrocytoma, 3 ganglioneuroma, 2 dysembryoplastic neuroepithelial tumor, 1 pleomorphic xantoastrocytoma, and 1 meningioangiomatosis. Mean follow-up time was 22 months and outcome was evaluated according to Engel's classification; 76.2% were classified in class I and 23.8% in II and III. All patients classes II and III had been submitted to mesial and neocortical resections. There were no differences related to clinical characteristics, pathological diagnosis or duration of follow-up in patients seizure-free or not. All patients had abnormal MRI and ten of these had normal CT; the MRI characteristics were compared to pathological diagnosis and specific histological characteristics of the tumors were not discernible by MRI. We concluded that MRI was essential for the diagnosis and precise location of TL tumors. Ganglioglioma was the most frequent tumor and lesionectomy associated to mesial resection doesn't guarantee a better prognosis.KEY WORDS: epilepsy, temporal tumor, clinical aspects, surgical outcome, MRI.Características clínicas, de neuroimagem estrutural e prognóstico cirúrgico de pacientes com tumor do lobo temporal e epilepsia RESUMO -Este é um estudo retrospectivo de 21 pacientes com epilepsia e tumores do lobo temporal tratados cirurgicamente. A avaliação incluiu dados clínicos, eletrencefalográficos, de neuroimagem, anatomia patológica e seguimento pós-operatório. Eram 9 casos de ganglioglioma, 5 de astrocitoma pilocítico, 3 de ganglioneuroma, 2 de tumor neuroectodérmico disembrioplástico, 1 de xantoastrocitoma pleomórfico e 1 de meningoangiomatose. A média de tempo de seguimento pós-operatório foi 22 meses e o prognóstico foi avaliado de acordo com a classificação de Engel; 76,2% encontravam-se na classe I e o restante nas classes II e III. Todos os pacientes que se encontravam nas classes II e III haviam sido submetidos a ressecção do tumor e de estruturas mesiais temporais. Não encontramos diferenças entre os grupos quanto as características clínicas, histológicas e tempo de seguimento. Dez pacientes apresentavam TC normal; os achados na RM foram comparados ao diagnóstico patológico, mas não encontramos características específicas relacionadas ao tipo de tumor. O estudo por RM foi essencial para o diagnóstico e localização precisa da lesão. Ganglioglioma foi o tumor mais freqüente e lesionectomia associada a ressecção mesial não proporcionou melhor prognóstico. PALAVRAS-CHAVE: epilepsia, tumor do lobo temporal, clínica, prognóstico cirúrgico e ressonância magnética.New neuroimaging techniques, especially MRI, have allowed more frequent detection of structural abnormalities, such as discrete neuronal migration disorders, gliosis and slow growing tumors in patients with medically refractory epilepsy 1 . Small growing tumors ...

Resective surgery for medically refractory epilepsy using intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients

“…In comparison with those found in the literature, our results match with the best reported results (Engel Class I seizure outcomes between 46.3% and 85.7% in those who underwent surgery for an LEAT). 3,18,32,33,41,45,46,48,53,63,64,82 As expected, in the few patients with diffuse gliomas treated for refractory epilepsy (16 of 415 patients), a high percentage (37.5% [6 of 16]) underwent second-look surgery because of the diffuse borders of such lesions. All other entities for which intraoperative second-look interventions were performed as a result of iMRI detecting an In summary, in concordance with a former investigation of our iMRI study group using low-field MRI, in which the rate of re-interventions resulting from insufficient resection was 14%, a very similar result was found in the current study with a 1.5-T high-field system.…”

Multifocal meningioangiomatosis in a 3-year-old patient

“…1,3,8,10,11,17 Seizures are usually simple or complex partial, and are notably and remarkably refractory to treatment (1,3,8,10,11). This condition is benign and treatable surgically, although resection can be complicated by the invasive nature of the tumor (1,3,8,10,11,17). When possible, complete resection can result in both cure of the tumor and resolution of seizures.…”

Early surgical intervention in adult patients with ganglioglioma is associated with improved clinical seizure outcomes

“…1,3,22,23,39 Though there are no definitive radiographic criteria that define GG, its radiological characteristics are helpful in establishing diagnosis. 57,73 The majority of these tumors appear on T1-weighted MRI as isointense or hypointense lesions, hyperintense on T2-weighted MRI, and hyopintense on fluid-attenuated inversion recovery imaging. 4,7,73,97,98 Approximately 40% to 50% of patients with GG show calcifications on CT scans, whereas 50% to 60% of tumors contain cystic components.…”