Intractable seizures associated with brain tumor in childhood: lesionectomy and seizure outcome

Abstract

The authors retrospectively reviewed ten pediatric brain tumor patients with intractable seizures who underwent lesionectomy without intentional identification and resection of the epileptogenic region to assess the clinical features and seizure outcome after lesionectomy in such patients. Seizures were complex partial in seven cases and simple partial, absence, and generalized tonic-clonic in one case each. Tumors were located at the medial temporal lobe in four cases, at the frontal lobe in four cases, at the parietooccipital and the suprasellar areas in one case each. The most common pathology was benign oligodendroglioma (five cases) followed by ganglioglioma (two cases). Others were pleomorphic xanthoastrocytoma, hamartoma, and primitive neuroectodermal tumor (one case each). In four cases, complete removal of the tumor was feasible. Postoperatively nine of the ten patients showed favorable seizure control (Engel's classification 1 and 2) and of these, six were seizure-free during the follow-up period (mean duration: 40 months). Therefore, lesionectomy can be an appropriate initial treatment for patients with brain tumor and medically intractable seizures.

Surgery in epilepsy associated with focal lesions in childhood

“…The results of this series and other recent reports [4,45,47,57] demonstrate that for children, good outcome can be expected when the decision for surgery is based on a good correlation among clinical, electrophysiological, and neuroradiological data. Further improvement in surgical selection of patients is likely to come after obtaining elaborate neuropsychological assessment, appropriate interictal and ictal video-EEG monitoring, and high-definition MR imaging examinations.…”

“…However, among factors implicated in surgical management, the nature of the lesion is not meaningless. As in this series, excision of low-grade tumors without resection of surrounding cortex has been reported to be associated with good outcome; [38,42,43,47,48] conversely, it is still debatable whether one should include in the surgical resection of cavernous angiomas the area of gliosis and hemosiderin deposition that usually surrounds the lesion. [36,57] In our series, any abnormal macroscopic tissue was removed despite lack of scientific evidence that this method improved results.…”

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

“…But how successful is tumour resection in terms of controlling or eliminating seizures? [214][215][216][217][218][219][220][221][222][223] published over the past two decades in which seizure outcomes in children and adolescents undergoing surgery to remove epileptogenic brain neoplasms were examined. Across these 26 studies are 741 patients, ranging in age from one month to 21 years of age, with a mean age of 9.1 years and a mean duration of post-operative follow-up of more than four years (overall mean=52 months, with individual study means ranging from 12 to 148 months).…”

“…Overall, the series with the lowest total resection rates were those that included a number of oligodendrogliomas (ODG), with resection rates ranging from 30% in a study exclusively of ODG and ODG-mixed lesions [96] and 40% in an older study in which half the patients had ODG [219], to 58% and 61% in studies in which the proportion of ODG was considerably lower [90,220]. This discovery is not unexpected, given the highly infiltrative nature of these tumours [77,96,97,191].…”

Focal Cortical Dysplasia with Glioproliferative Changes Causing Seizures: Report of 3 Cases

“…This disorder is generally interpreted as a developmental process of abnormal neuronal migration, with minimal risk of subsequent neoplastic transformation [1][2][3][4][5][6][7][8][9][10]. In contrast, epileptogenic neoplastic lesions, even if low grade, are known to have a potential for growth and recurrence [3,8,11,12]. We recently treated 3 children who presented with seizures arising from lesions found on resection to demonstrate both focal cortical dysplasia and regions of hypercellular and monomorphic glial proliferation resembling glioma.…”