Seizure outcome with surgical management of epileptogenic ganglioglioma: a study of 55 patients

Hu, Wenhan; Ge, Ming; Zhang, Kai; Meng, Fangang; Zhang, Jianguo

doi:10.1007/s00701-011-1259-z

Cited by 39 publications

(51 citation statements)

References 40 publications

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“…A subsequent report 20 describing 55 patients with epileptogenic ganglioglioma revealed 48 (87%) Engel Class I outcomes, consistent with prior studies, but did not show extent of resection to be a significant predictor of seizure outcome. Intraoperative ECoG, used in 42 patients, also did not affect outcome, and neither did a temporal versus an extratemporal tumor location.…”

Section: Oncological Perspectivesupporting

confidence: 78%

“…7 This includes case series in which ECoG was used to localize interictal spikes intraoperatively and ictal onset extraoperatively. 8,20,23,28 Although GTR is not always technically achievable, this limitation does not necessarily leave patients in these cases with ongoing uncontrolled epilepsy. However, the treatment factors that could predispose toward a good outcome in the context of STR have not been well established.…”

Section: Discussionmentioning

confidence: 99%

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Seizure control after subtotal lesional resection

Gump

Skjei

Karkare

2013

FOC

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Reports on seizure outcomes following surgery for lesional epilepsy consistently cite extent of resection as a significant predictor of outcome. Unfortunately, gross-total resection is not technically feasible in all cases of medically refractory tumor-associated epilepsy. Here, the authors present the case of a 4-year-old girl whose epilepsy was medically controlled after 1-stage electrocorticography-guided subtotal resection (STR) of a large diffuse protoplasmic astrocytoma. They also review the modern literature on epilepsy associated with brain tumors. Outcomes are compared with those following surgical treatment of focal cortical dysplasia and vascular lesions. Gross-total lesional resection shows significant superiority across pathologies and anatomical regions. Despite a considerable number of STRs yielding seizure freedom, other favorable treatment factors have not been defined. Although gross-total lesional resection, if possible, is clearly superior, tailored surgery may still offer patients a significant opportunity for a good outcome. Treatment factors yielding successful seizure control following STR remain to be fully elucidated.

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Section: Oncological Perspectivesupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Seizure control after subtotal lesional resection

Gump

Skjei

Karkare

2013

FOC

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“…Compared with total resection rates between 61% and 76% reported after "conventional" surgery without the use of intraoperative resection control, our results are very promising. 9,16,24,31 Although the patients who underwent surgery that included neuronavigation/iopMRI had lesions close to eloquent brain areas, and therefore had a higher risk of incomplete resection than those patients who underwent surgery without the multimodal approach, we achieved better results regarding excellent seizure control (73% vs 58% Engel Class IA). Although GTR for the whole study population and GTR after the first intraoperative highfield MR scan for the subgroup using this multimodal approach were identified as one of the prognostic factors for freedom from seizures, one has to keep in mind the different sample sizes used for the statistical analysis (see "Study Limitations" below).…”

Section: Discussionmentioning

confidence: 85%

Resection of cerebral gangliogliomas causing drug-resistant epilepsy: short- and long-term outcomes using intraoperative MRI and neuronavigation

Wimmer¹,

Coras

Blümcke

et al. 2015

FOC

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OBJECT Cerebral gangliogliomas (GGs) are highly associated with intractable epilepsy. Incomplete resection due to proximity to eloquent brain regions or misinterpretation of the resection amount is a strong negative predictor for local tumor recurrence and persisting seizures. A potential method for dealing with this obstacle could be the application of intraoperative high-field MRI (iopMRI) combined with neuronavigation. METHODS Sixty-nine patients (31 female, 38 male; median age 28.5 ± 15.4 years) suffering from cerebral GGs were included in this retrospective study. Five patients received surgery twice in the observation period. In 48 of the 69 patients, 1.5-T iopMRI combined with neuronavigational guidance was used. Lesions close to eloquent brain areas were resected with the implementation of preoperative diffusion tensor imaging tractography and blood oxygenation level–dependent functional MRI (15 patients). RESULTS Overall, complete resection was accomplished in 60 of 69 surgical procedures (87%). Two patients underwent biopsy only, and in 7 patients, subtotal resection was accomplished because of proximity to critical brain areas. Excluding the 2 biopsies, complete resection using neuronavigation/iopMRI was documented in 33 of 46 cases (72%) by intraoperative imaging. Remnant tumor mass was identified intraoperatively in 13 of 46 patients (28%). After intraoperative second-look surgery, the authors improved the total resection rate by 9 patients (up to 91% [42 of 46]). Of 21 patients undergoing conventional surgery, 14 (67%) had complete resection without the use of iopMRI. Regarding epilepsy outcome, 42 of 60 patients with seizures (70%) became completely seizure free (Engel Class IA) after a median follow-up time of 55.5 ± 36.2 months. Neurological deficits were found temporarily in 1 (1.4%) patient and permanently in 4 (5.8%) patients. CONCLUSIONS Using iopMRI combined with neuronavigation in cerebral GG surgery, the authors raised the rate of complete resection in this series by 19%. Given the fact that total resection is a strong predictor of long-term seizure control, this technique may contribute to improved seizure outcome and reduced neurological morbidity.

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“…There are still several controversies regarding surgical treatment of patients with temporal LGG and no standard guide exists showing the best surgical approach to this patients. There have been mainly four types of surgery including standard anterior temporal resection only, standard anterior temporal with amygdalohippocampectomy, extended lesionectomy with amygdalo-hippocampectomy and extended lesionectomy 19,23,24,25,26 . We generally performed the following protocol: in non-dominant temporal lobe, tumor removal was done by standard anterior temporal with amygdalohippocampectomy; but in case of dominant side, we respected the mesial structures and performed extended lesionectomy.…”

Section: Discussionmentioning

confidence: 99%

Gross-total resection of temporal low grade gliomas is a critically important factor in achieving seizure-freedom

Meguins

Adry

Júnior

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective To present a surgical series of patients with low grade temporal gliomas causing intractable epilepsy, focusing on long-term seizure outcome.Method A retrospective study was conducted with patients with temporal low-grade gliomas (LGG).Results Sixty five patients with were operated in our institution. Males were more affected than females and the mean age at surgery was 32.3 ± 8.4 (9-68 years). The mean age at seizure onset was 25.7 ± 9.2 (11-66 years). Seizure outcome was classified according with Engel classification. After one year of follow up, forty two patients (64.6%) were Engel I; seventeen (26.2%) Engel II; four (6.2%) Engel III and two (3.1%) Engel IV. Statistically significant difference in seizure outcome was obtained when comparing the extension of resection. Engel I was observed in 39 patients (69.6%) with total resection and in only 3 (33.3%) patients with partial resection.Conclusion Gross-total resection of temporal LGGs is a critically important factor in achieving seizure-freedom.

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Seizure outcome with surgical management of epileptogenic ganglioglioma: a study of 55 patients

Cited by 39 publications

References 40 publications

Seizure control after subtotal lesional resection

Seizure control after subtotal lesional resection

Resection of cerebral gangliogliomas causing drug-resistant epilepsy: short- and long-term outcomes using intraoperative MRI and neuronavigation

Gross-total resection of temporal low grade gliomas is a critically important factor in achieving seizure-freedom

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