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

Yang, Isaac; Chang, Edward F.; Han, Seunggu J.; Barry, Jeffrey J.; Fang, Shanna; Tihan, Tarık; Barbaro, Nicholas M.; Parsa, Andrew T.

doi:10.1016/j.jocn.2010.05.002

Cited by 46 publications

(40 citation statements)

References 94 publications

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“…Compared with total resection rates between 61% and 76% reported after "conventional" surgery without the use of intraoperative resection control, our results are very promising. 9,16,24,31 Although the patients who underwent surgery that included neuronavigation/iopMRI had lesions close to eloquent brain areas, and therefore had a higher risk of incomplete resection than those patients who underwent surgery without the multimodal approach, we achieved better results regarding excellent seizure control (73% vs 58% Engel Class IA). Although GTR for the whole study population and GTR after the first intraoperative highfield MR scan for the subgroup using this multimodal approach were identified as one of the prognostic factors for freedom from seizures, one has to keep in mind the different sample sizes used for the statistical analysis (see "Study Limitations" below).…”

Section: Discussionmentioning

confidence: 88%

Resection of cerebral gangliogliomas causing drug-resistant epilepsy: short- and long-term outcomes using intraoperative MRI and neuronavigation

Wimmer¹,

Coras

Blümcke

et al. 2015

FOC

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OBJECT Cerebral gangliogliomas (GGs) are highly associated with intractable epilepsy. Incomplete resection due to proximity to eloquent brain regions or misinterpretation of the resection amount is a strong negative predictor for local tumor recurrence and persisting seizures. A potential method for dealing with this obstacle could be the application of intraoperative high-field MRI (iopMRI) combined with neuronavigation. METHODS Sixty-nine patients (31 female, 38 male; median age 28.5 ± 15.4 years) suffering from cerebral GGs were included in this retrospective study. Five patients received surgery twice in the observation period. In 48 of the 69 patients, 1.5-T iopMRI combined with neuronavigational guidance was used. Lesions close to eloquent brain areas were resected with the implementation of preoperative diffusion tensor imaging tractography and blood oxygenation level–dependent functional MRI (15 patients). RESULTS Overall, complete resection was accomplished in 60 of 69 surgical procedures (87%). Two patients underwent biopsy only, and in 7 patients, subtotal resection was accomplished because of proximity to critical brain areas. Excluding the 2 biopsies, complete resection using neuronavigation/iopMRI was documented in 33 of 46 cases (72%) by intraoperative imaging. Remnant tumor mass was identified intraoperatively in 13 of 46 patients (28%). After intraoperative second-look surgery, the authors improved the total resection rate by 9 patients (up to 91% [42 of 46]). Of 21 patients undergoing conventional surgery, 14 (67%) had complete resection without the use of iopMRI. Regarding epilepsy outcome, 42 of 60 patients with seizures (70%) became completely seizure free (Engel Class IA) after a median follow-up time of 55.5 ± 36.2 months. Neurological deficits were found temporarily in 1 (1.4%) patient and permanently in 4 (5.8%) patients. CONCLUSIONS Using iopMRI combined with neuronavigation in cerebral GG surgery, the authors raised the rate of complete resection in this series by 19%. Given the fact that total resection is a strong predictor of long-term seizure control, this technique may contribute to improved seizure outcome and reduced neurological morbidity.

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Section: Discussionmentioning

confidence: 88%

Resection of cerebral gangliogliomas causing drug-resistant epilepsy: short- and long-term outcomes using intraoperative MRI and neuronavigation

Wimmer¹,

Coras

Blümcke

et al. 2015

FOC

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“…According to the WHO classification [8], GG with anaplastic glial features are considered WHO grade III. Early surgical resection of GG reduces long-term morbidity and mortality from seizures, making surgery the treatment of choice [9][10][11]. Gross total resection is recommended, even if significant reduction of symptoms, including freedom from seizures, can be often achieved with partial resection.…”

Section: Clinical and Neuropathologic Featuresmentioning

confidence: 99%

Epilepsy Related to Developmental Tumors and Malformations of Cortical Development

Aronica

Crino

2014

Neurotherapeutics

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“…Most studies have demonstrated that early intervention [26,38] and complete tumor resection [4,15,17,23] lead to better seizure control and survival. However, some factors that may influence seizure outcome have not been discussed or are controversial.…”

Section: Introductionmentioning

confidence: 99%

Seizure outcome with surgical management of epileptogenic ganglioglioma: a study of 55 patients

Zhang

et al. 2012

Acta Neurochir

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Surgical treatment is effective and safe for patients with epileptogenic gangliogliomas. Early surgical intervention is necessary for achieving early seizure control. Neither intraoperative ECoG nor IOUS necessarily leads to better seizure control, although the latter can be helpful in achieving complete tumor resection. Simple lesionectomy is sufficient for favorable postoperative seizure outcome.

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

Cited by 46 publications

References 94 publications

Resection of cerebral gangliogliomas causing drug-resistant epilepsy: short- and long-term outcomes using intraoperative MRI and neuronavigation

Resection of cerebral gangliogliomas causing drug-resistant epilepsy: short- and long-term outcomes using intraoperative MRI and neuronavigation

Epilepsy Related to Developmental Tumors and Malformations of Cortical Development

Seizure outcome with surgical management of epileptogenic ganglioglioma: a study of 55 patients

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