Surgical treatment of refractory epilepsy associated with space occupying lesions experience and review

Abstract

-Surgery for space occupying lesions of the brain associated with intractable epilepsy represents a special problem because relief of the epilepsy is as much an operative goal as excision of the space occupying lesion itself. This study concerns 32 patients with space occupying lesions and intractable epilepsy who underwent excision of the lesion with acute intraoperative electrocorticography guided resection of the epileptogenic focus. Of the 32 patients, 16 formed a subgroup of gangliogliomas alone. The remaining were mixed lesions, predominantly benign. The duration of seizures in these patients ranged from 2 to 30 years, and the seizure frequency varied from 1 to 300 convulsions per month. The operative procedures included temporal corticectomy, amygdalo-hippocampectomy, and extratemporal corticectomies. Twenty nine patients were in Engel class I postoperatively, and three patients were in Engel class II. The findings with gangliogliomas are also considered in a separate group. This study strongly suggests that the operative procedure under electrocorticography guidance improves seizure outcome in space occuping lesions related intractable epilepsy.KEY WORDS: brain tumor, ganglioglioma, refractory epilepsy, electrocorticography.Tratamento cirúrgico da epilepsia refratária associada a lesões expansivas: experiência e revisão RESUMO -O tratamento cirúrgico das lesões que ocupam espaço (LOE) do sistema nervoso associadas a epilepsia intratável representa um problema clínico especial, já que tanto o tratamento da lesão como o da epilepsia são relevantes. Estudaram-se 32 pacientes com LOEs que foram submetidos a lesionectomia com margens guiadas por eletrocorticografia. Destes, 16 possuíam gangliogliomas e os restantes lesões variadas, predominantemente benignas. A duração das crises nesses pacientes variou de 2 a 30 anos e a frequência das crises de 1 a 300 por mês. Os procedimentos cirúrgicos incluíram corticectomia temporal, amigdalo-¬ hipocampectomia e corticectomias extra-temorais. Vinte e nove pacientes estvam em grau I de Engel pós-¬ operatoriamente e 3 em grau II. Os achados em relação aos gangliogliomas foram também estudados separadamente. Este estudo sugere que a inclusão da eletrocorticografia e da ressecção das margens epileptogênicas em pacientes com LOEs e epilepsia refratária melhoram os resultados obtidos em relação às crises. PALAVRAS-CHAVE: tumor cerebral, ganglioglioma, epilepsia refratária, eletrocorticografia.The surgical treatment of space occupying lesions (SOLs) of the brain associated with refractory epilepsy is an issue dogged by controversy. In such patients, surgery is directed as much towards the relief of seizures, as it is towards cure of the tumor. Many such patients are on supra-maximal doses of anticonvulsant therapy, freedom from which is another important goal. Many neurosurgeons believe that simple excision of the lesion alone is inadequate for this purpose'.

Optimal seizure management in brain tumor patients

“…A small retrospective study from Brazil on 32 patients with a brain tumor and intractable epilepsy showed comparable results of neurosurgical treatment of the tumor together with the epileptogenic zone [46].…”

“…Effect of neurosurgery on tumor-related intractable epilepsyZentner et al[43] Morris et al[44] Luyken et al[45] Brainer-Lima et al[46] …”

Epilepsia parcial associada a tumores cerebrais primários

“…Outros estudos com populações heterogêneas de tumor cerebral de crescimento lento também demonstraram a predominância da crise epiléptica parcial 18,19 . Award et al 20 descreveram 47 pacientes com tumor cerebral primário e epilepsia refratária, nos quais a PC não foi específica para a localização anatômica da lesão, podendo ocorrer em lesões temporais ou extra-temporais.…”

Seizure control in brain tumors

“…In addition, for intractable epilepsy associated with brain tumors, surgery may also be considered, and satisfying results with regard to seizure reduction have been reported (Brainer-Lima et al, 1996;Zentner et al, 1997;Luyken et al, 2003;Bromfield, 2004;Cascino, 2004;Paolini et al, 2006). In addition, for intractable epilepsy associated with brain tumors, surgery may also be considered, and satisfying results with regard to seizure reduction have been reported (Brainer-Lima et al, 1996;Zentner et al, 1997;Luyken et al, 2003;Bromfield, 2004;Cascino, 2004;Paolini et al, 2006).…”