Surgical Treatment of Neoplasms Associated with Medically Intractable Epilepsy

Zentner, Josef; Hufnagel, A.; Wolf, Helmut K.; Ostertun, B.; Behrens, Elga; Campos, Manuel; Eiger, Christian E.; Wiestler, Otmar D.; Schramm, Johannes

doi:10.1097/00006123-199708000-00008

Cited by 152 publications

(104 citation statements)

References 46 publications

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“…If one examines the larger series that has been reported, gangliogliomas, dysembryoplastic neuroepithelial tumors, and low-grade astrocytomas are the most commonly encountered neoplasms. [1][2][3][4][5][6] In general, these tumors tend to present earlier in life, frequently in childhood, and generally represent low-grade lesions (WHO grade-I or II tumors). The incidence of various tumor types in this study in patients with dual pathology seems to be consistent with these findings in that gangliogliomas and dysembryoplastic neuroepithelial tumors represent the two most commonly encountered tumor types.…”

Section: Discussionmentioning

confidence: 99%

“…A number of series have examined the incidence of various tumor types encountered in the setting of medically intractable epilepsy. [1][2][3][4][5][6] The prevalence of tumors in this setting has ranged from 12.6 to 56.3%. [7][8][9][10] In a subset of these tumors, which are generally low-grade glial or glioneuronal neoplasms, multiple pathologies, which potentially may contribute to the genesis of these seizures, are identifiable (dual pathology).…”

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confidence: 99%

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Coexistent pathology in chronic epilepsy patients with neoplasms

2010

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Coexistent pathology in chronic epilepsy patients with neoplasms

2010

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“…12,17,19 In tumor-related TLE, the surgical procedure may be limited to lesionectomy (tumor resection) or be extended up to the standard temporal lobectomy. To the best of our knowledge, little evidence is available regarding this issue, mainly because well-matched comparisons of surgical procedures are difficult to undertake in these heterogeneous patients.…”

Section: Surgical Strategymentioning

confidence: 99%

Long‐term surgical outcomes of temporal lobe epilepsy associated with low‐grade brain tumors

Phi

Kim

Cho

et al. 2009

Cancer

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“…19,26,27,32 GGs are especially responsible for a large proportion of patients with drug-resistant seizures, particularly when located in the temporal lobe.17,30 With 60%-95% of patients presenting with seizures as a primary symptom, between 20% and 40% develop drug-resistant epilepsy. 24,32 Complete resection of tumorous lesions associated with epilepsy remains the major goal of surgery, which is associated with freedom from seizures 7,15 and prolonged overall and progression-free survival in high percentages.…”

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confidence: 99%

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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Surgical Treatment of Neoplasms Associated with Medically Intractable Epilepsy

Cited by 152 publications

References 46 publications

Coexistent pathology in chronic epilepsy patients with neoplasms

Coexistent pathology in chronic epilepsy patients with neoplasms

Long‐term surgical outcomes of temporal lobe epilepsy associated with low‐grade brain tumors

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

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