Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”: A retrospective nationwide Italian study

Giulioni, Marco; Marucci, Gianluca; Pelliccia, Veronica; Gozzo, Francesca; Barba, Carmen; Didato, Giuseppe; Villani, Flavio; Gennaro, Giancarlo Di; Quarato, Pier Paolo; Esposito, Vincenzo; Consales, Alessandro; Martinoni, Matteo; Vornetti, Gianfranco; Zenesini, Corrado; Marras, Carlo Efisio; Specchio, Nicola; Palma, Luca De; Rocchi, Raffaele; Tringali, Giovanni; Nozza, Paolo; Colicchio, Gabriella; Rubboli, Guido; Russo, Giorgio Lo; Guerrini, Renzo; Tinuper, Paolo; Cardinale, Francesco; Cossu, Massimo

doi:10.1111/epi.13866

Cited by 49 publications

(59 citation statements)

References 39 publications

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“…The study included 107 children and is one of the largest series to date in this population. 6,9,12 Our Engel class I outcome of 84% was consistent with previously published studies. 3,5,8,13,18 Interestingly, Englot et al found a similar rate of Engel class I in the largest systematic literature review of seizure outcomes after resection of neuronal-glial tumors.…”

Section: Discussionsupporting

confidence: 90%

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Epilepsy outcome following resection of low-grade brain tumors in children

Mohan

Weiner

Mohila

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe indication for and timing of surgery for epilepsy associated with low-grade mixed neuronal-glial tumors may be controversial. The purpose of this study was to evaluate the effect of resection and associated variables on epilepsy and on progression-free survival (PFS).METHODSA retrospective chart review of patients treated between 1992 and 2016 was conducted to identify individuals with epilepsy and low-grade gliomas or neuronal-glial tumors who underwent resective surgery. Data analyzed included age at epilepsy onset, age at surgery, extent of resection, use of electrocorticography, the number of antiepileptic drugs (AEDs) before and after surgery, the presence of dysplasia, Engel class, histological findings, and PFS. The institutional review board protocol was specifically approved to conduct this study.RESULTSA total of 107 patients were identified. The median follow-up was 4.9 years. The most common pathology was dysembryoplastic neuroepithelial tumor (36.4%), followed by ganglioglioma (31.8%). Eighty-four percent of patients had Engel class I outcomes following surgery. Gross-total resection was associated with a higher likelihood of an Engel class I outcome (90%) as compared to subtotal resection (58%) (p = 0.0005). Surgery reduced the AED burden, with 40% of patients requiring no AEDs after surgery (p < 0.0001). Children with neurodevelopmental comorbidities (n = 5) uniformly did not experience seizure improvement following resection (0% vs 83% overall; p < 0.0001). Electrocorticography was used in 33% of cases and did not significantly increase class I outcomes. PFS was 90% at 5 years. Eleven percent of tumors recurred, with subtotal resection more likely to result in recurrence (hazard ratio 5.3, p = 0.02). Histological subtype showed no significant impact on recurrence.CONCLUSIONSGross-total resection was strongly associated with Engel class I outcome and longer PFS. Further studies are needed to elucidate the suitable time for surgery and to identify factors associated with oncological transformation.

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Section: Discussionsupporting

confidence: 90%

“…1,2 Last, data exist to support the idea that oncological follow-up and treatment is essential for these tumors. 9 A small percentage of these neuronal-glial tumors can become malignant. One study reports that some tumors recurred as malignancies.…”

mentioning

confidence: 99%

Epilepsy outcome following resection of low-grade brain tumors in children

Mohan

Weiner

Mohila

et al. 2019

Journal of Neurosurgery: Pediatrics

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“…15,43,45,47,48,50,52,54,55,66) In an Italian nationwide study of epilepsy surgery for LEATs that included a total of 282 adults and children, older age at surgery was the most significant predictor of persistent seizures, with a 4% increase in the probability of an unfavorable outcome for every year waited. 16) Since previous studies de monstrated no significant difference in surgical outcome between pediatric and adult patients with LEATs, 16,56) the reason for the poor prognosis associated with older age at surgery may be the duration of epilepsy rather than the patient's age itself.…”

Section: Age At Surgerymentioning

confidence: 99%

“…The discordance among previous studies also raises an important question regarding the use of additional corticectomy or additional amygdalohippocampectomy for temporal lobe tumors. 14,16,23,56,60,[67][68][69] Extended resections are mainly performed for temporal tumors, while there is a lack of reports detailing outcomes for extratemporal tumors. 43,67,[69][70][71] One indicator that endorses the application of extended tailored resection is the presence of adjacent dual pathology, such as focal cortical dysplasia or hippocampal sclerosis, that can cause seizures after lesionectomy.…”

Section: Extent Of Resectionmentioning

confidence: 99%

“…LEATs are extremely responsive to surgical treatment, and more than 80% of patients achieve seizure freedom after surgery. [13][14][15][16] Therefore, epilepsy surgery should be considered a treatment option for LEATs. However, the optimal surgical timing remains controversial, and surgeries are often delayed (Table 1), mostly due to late referral after lengthy trials of antiepileptic drugs (AEDs), with a mean duration from seizure onset to surgery (i.e., duration of epilepsy) of more than 10 years.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with seizure and cognitive outcomes after epilepsy surgery for low-grade epilepsy-associated neuroepithelial tumors in children

Lee

2020

Clin Exp Pediatr

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Low-grade epilepsy-associated neuroepithelial tumors (LEATs) are responsible for drug-resistant chronic focal epilepsy, and are the second-most common reason for epilepsy surgery in children. LEATs are extremely responsive to surgical treatment, and therefore epilepsy surgery should be considered as a treatment option for LEATs. However, the optimal time for surgery remains controversial, and surgeries are often delayed. In this review, we reviewed published article on the factors associated with seizure and cognitive outcomes after epilepsy surgery for LEATs in children to help clinicians in their decision whether to pursue epilepsy surgery for LEATs. The achievement of gross total resection may be the most important prognostic factor for seizure freedom. A shorter duration of epilepsy, a younger age at surgery, and extended resection of temporal lobe tumors have also been suggested as favorable prognostic factors in terms of seizure control. Poor cognitive function in children with LEATs is associated with a longer duration of epilepsy and a younger age at seizure onset.

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Low‐grade epilepsy‐associated tumors: Epilepsy outcome and antiseizure medication discontinuation after lesionectomies as first‐line surgical approach in pediatric population

Bernardo,

Scala,

Rubino

et al. 2024

Epileptic Disorders

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ObjectiveThis study aimed to evaluate epilepsy outcome and antiseizure medication (ASM) discontinuation after lesionectomies as first surgical approach in pediatric population diagnosed with low‐grade epilepsy‐associated neuroepithelial tumors (LEATs).MethodsWe conducted a retrospective study. Thirty‐six consecutive patients with histological diagnoses of LEATs who underwent surgery between 2018 and 2021 at our institution were included. The clinical and surgical data were retrospectively analyzed.ResultsThirty (83.3%) of 36 patients are free of disabling seizures (Engel class I) and 19 (63,4%) of them are classified as Engel Ia. In 17 (47.2%) patients, ASM could be discontinued. The mean age at surgery was 8.6 years (±4.04) and the mean age at onset of epilepsy was 7.2 years (±3.8), whereas the mean duration of epilepsy in months at the time of surgery was 21.3 months (±23.7). The epileptogenic tumor was in the temporal lobe in 20 (55.5%) patients. Because of seizure persistence, a second or a third surgery was necessary for six patients (16.7%) and four of them had residual lesions (three in temporal and one in extratemporal site). No perioperative complications were recorded, including acute seizures, with a median hospitalization time of 7 days. Shorter epilepsy duration at time of surgery as long as a single ASM was significantly correlated with an Engel class I outcome (p‐value = .01 and p‐value = .016, respectively). Focal seizure semeiology was associated with an increased probability of antiseizure medication discontinuation (p‐value = .042).SignificanceOur findings confirm that shorter epilepsy disease duration, monotherapy before surgery, and seizure semeiology are determinant factors for a positive seizure outcome and medication discontinuation, also with less invasive surgical approaches such as lesionectomies. However, considering the intrinsic multifactorial epileptogenic nature of LEATs, a tailored surgical approach should be considered to optimize clinical and seizure outcome, especially for lesions located in the temporal lobe.

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Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”: A retrospective nationwide Italian study

Cited by 49 publications

References 39 publications

Epilepsy outcome following resection of low-grade brain tumors in children

Epilepsy outcome following resection of low-grade brain tumors in children

Factors associated with seizure and cognitive outcomes after epilepsy surgery for low-grade epilepsy-associated neuroepithelial tumors in children

Low‐grade epilepsy‐associated tumors: Epilepsy outcome and antiseizure medication discontinuation after lesionectomies as first‐line surgical approach in pediatric population

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