Epilepsy surgery following brain tumor resection in children

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Intractable epilepsy following successful brain tumor surgery in children may have several underlying causes such as residual tumor, cortical dysplasia, and gliosis. The authors reviewed the cases of children who had previously undergone resection of a brain tumor only to have medically refractory seizures postoperatively.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors performed a retrospective case review of 9 children who underwent brain tumor surgery 2–13 years before undergoing a second surgery to try and control their seizures.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Eight of 9 children had seizures at the time of tumor presentation. Tumor types included ganglioglioma, dysembryoplastic neuroepithelial tumor, pilocytic astrocytoma, oligodendroglioma, ependymoma, and choroid plexus papilloma. All patients achieved a seizure-free interval before intractable seizures recurred. After the second operation, 3 children were seizure free, 1 only had auras, 2 had rare complex partial seizures, and 3 continued to have relatively frequent seizures, although the frequency and severity were reduced. Seven of 9 patients had pathology showing residual tumor.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Epilepsy surgery following earlier brain tumor surgery can provide substantial benefit with reduced seizure number and severity. Despite reassuring brain imaging results, residual tumor was present more often than expected in pathological specimens.</jats:p></jats:sec>

Utility of Epilepsy Surgery in Survivors of Childhood Cancer

“…Although a small but significant proportion of children who undergo epilepsy surgery are found to have brain tumors, we are aware of only one published report on seizure outcome after epilepsy surgery in childhood brain tumor survivors. 9 That study of nine children by Tian et al reported encouraging seizure outcomes similar to ours. However, they found residual tumor in almost 100% pathological samples, whereas we found residual tumor in only three (33%) of the nine brain tumor survivors.…”

Epilepsy surgery after treatment of pediatric malignant brain tumors

“…High grade brain tumors can be associated with epilepsy requiring aggressive medical management, 8,[38][39][40] yet surgical options in survivors is rarely reported, even in series focusing on brain tumors and epilepsy. [11][12][13][14]20 Unfortunately, seizure control appears to be incomplete in many of these patients. In addition to the impact of seizures on quality of life, 6 medication side effects are also a significant concern.…”

“…1,2 The frequency is higher among low grade tumors (60-85%) than among high grade tumors 20-40%. [3][4][5][6][7][8][9][10][11][12][13] Although treatment with initial anticonvulsants and surgery may be sufficient to prevent longterm epilepsy, 9,14,15 recurrent seizures occur 7,16 often in the setting of tumor recurrence. 10,17 Repeated seizures, refractory to medical management, has been reported in 14-20% of patients with primary brain tumors.…”

Dysembryoplastic neuroepithelial tumor originally diagnosed as astrocytoma and oligodendroglioma

“…It is well-known that larger samples are usually necessary to show the classical architecture of a DNT 3 . Control of seizures was obtained in 50% of the patients, as opposed to 80 to 100% [20][21][22] , which is directly related to the extent of resection 8,12,23 . We could observe that the management of seizures was more effective after total resection of the lesion than with partial resection, which has also been applied for the four re-classified tumors, one of which underwent a biopsy, and as expected, did not improve clinically.…”