Seizure outcome of epilepsy surgery in focal epilepsies associated with temporomesial glioneuronal tumors: lesionectomy compared with tailored resection

Abstract

The authors' results demonstrate a better seizure outcome for temporomesial glioneuronal tumors associated with epilepsy in patients who underwent tailored resection rather than simple lesionectomy (p = 0.005). For temporomesial glioneuronal tumors associated with epilepsy, performing a presurgical noninvasive neurophysiological study intended to identify the epileptogenic zone is necessary for planning a tailored surgery. Using this surgical strategy, the presence of temporomesial glioneuronal tumors constitutes a predictive factor of excellent seizure outcome, and therefore surgical treatment can be offered early to avoid both the consequences of uncontrolled seizures as well as the side effects of pharmacological therapy.

Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications

“…The specific role of each one of these pathological lesions in epileptogenesis is still not well defined. 5,14,22,25,43,44,58,59,69,75 Finally, in our series we found ELGT associated with MTS in 2 cases (10%), in agreement with previous data that reported this association in 2%-25% of cases. 14,16,86,98 In the setting of ELGT, the distinction among the various subtypes of tumors is essential for predicting the seizure outcome and the oncological behavior.…”

“…17,80 In addition, we observed statistically significant differences in a retrospective study comparing seizure outcome in 2 homogeneous series of temporomesial ELGTs, one treated with simple lesionectomy, the other with lesionectomy and tailored resection of the epileptogenic zone; in fact, only 42.8% of those treated by lesionectomy alone were seizurefree (according to the Engel classification) 32 compared with 93% of those who underwent a tailored resection. 44 We confirmed these results in a recent retrospective pediatric series. 4 The higher effectiveness of an extended resection, beyond the low-grade tumor, might depend on the frequent association of this tumor type with other epileptogenic pathologies, such as the spectrum of cortical dysplasias that might represent the origin of a widespread epileptic network.…”

“…39,40,68 Therefore, considering the good prognosis for epilepsy and the possible, although low, risk of malignant transformation, we think that ELGTs should be properly and quickly diagnosed by adequate imaging investigations and considered early for surgical treatment, particularly in young patients, to avoid psychosocial consequences and disability due to long-standing medically intractable seizures. 23,31,33,34,41,42,44,45,76,99 In our group of 17 patients with isolated FCD, we identified FCD Type IIa in 11 patients, FCD Type Ic in 6 patients. Of the patients with FCD Type IIa, 8 (72.7%) had Class I outcomes, 7 of them (63.6% of the FCD IIa group) had Class IA, whereas considering FCD Type Ic, (Engel Class I outcome was observed in 2 (33.3%) of 6 patients, with only 1 patient (16.6%) having a Class IA outcome.…”

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

“…In such patients, post-operative seizure-freedom rates often approach or exceed 80% [35,48,51,58,66,86,88,90,93,115,157,[161][162][163][164][165][166][167][168][169].…”

The history of surgical treatment of epilepsy in the Russian Federation

“…Достаточно много публи-каций, посвященных эффективности удалений в границах поражения при эпилепсии, ассоциирован-ной с опухолями головного мозга [36], пороками развития коры [37], и медиальным склерозом [38]. При этом утверждалось, что применение интраопе-рационной электрокортикографии не улучшает ре-зультатов лечения [38] и не дает адекватного пред-ставления о границах эпилептогенной зоны [39].…”