Seizure outcome in temporal glioblastoma surgery: lobectomy as a supratotal resection regime outclasses conventional gross-total resection

Abstract

Introduction The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures. Methods Between 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors’ institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2–6). Results Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4–515.9). Conclusions ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.

Beyond the neuro-oncological outcome: A perspective of the seizure control after resection of the medial temporal lobe gliomas

“…They believe that LGGs are not limited to the area shown by MRI, and part of the normal temporal neocortex in preoperative imaging may also be involved by the tumor histologically. [2,[5][6][7] We agree with the authors that optimal intervention for both oncological and an epileptologic outcome is total tumor removal along with resection of all probable epileptogenic foci. However, such a practice may be overdoing in some cases, posing them to the risks of an extended resection without adding any benefit to the outcome.…”

“…They believe that LGGs are not limited to the area shown by MRI, and part of the normal temporal neocortex in preoperative imaging may also be involved by the tumor histologically. [ 2 5 6 7 ]…”

Clinical and prognostic implications of rim restriction following glioma surgery

“…The GBM population showed a significant decrease in the rate of seizures following surgical resection, and these results are in line with previous reports regarding the beneficial effects of surgery in alleviating seizures among glioma patients, yet no differences were noted in relation to post-op restriction status. 31 , 32 .…”

Converging Mechanisms of Epileptogenesis and Their Insight in Glioblastoma

“…Patients who have undergone gross total tumor resection (GTR; >80%) are much more likely to be seizure-free post-operatively than sub-total resection (SubTR; <70%; Liang et al, 2016 ). Still significantly higher rates of seizure freedom are seen with supra-total resection (SupraTR; >100%) in the form of anterior temporal lobectomy (ATL; Borger et al, 2021 ). Comprehensive investigations into the effect of seizures on risk of tumor recurrence and how this is impacted by EOR have not yet been reported.…”