Temporal lobe gangliogliomas associated with chronic epilepsy: Long-term surgical outcomes

Wallace, David J.; Ruban, Dmitry; Kanner, Andrés M.; Smith, Michael C.; Pitelka, Lisa; Stein, Jonathan H.; Vannemreddy, Prasad; Whisler, Walter W.; Byrne, Richard W.

doi:10.1016/j.clineuro.2012.05.034

Cited by 17 publications

(14 citation statements)

References 21 publications

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“…Compared with existing series, an Engel Class I outcome was reported in 63%-79% of patients undergoing epilepsy surgery. 29,32 In a 2012 literature review by Southwell et al, 24 the proportions of seizure-free adult patients with GGs were reported to be between 45% and 100%. However, 13 of 19 of the listed studies consisted of small case series (≤ 30).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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

View full text Add to dashboard Cite

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“…However, these tumours are almost always associated with seizures. Consequently, they comprise a disproportionate percentage of tumour-associated epilepsy cases [28,44,62,73,88,89,91,94,95]. Moreover, DNETs tend to be extremely resistant to AED therapy [62,[182][183][184][185][186].…”

Section: Aeds For Seizure Controlmentioning

confidence: 99%

“…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].…”

Section: General Principles Of Managementmentioning

confidence: 99%

“…Virtually every possible tumour type has been reported presenting as seizures, especially lowgrade gliomas [27, 30, 32, 34, 37, 39, 70-72, 75, 76, 78, 91-93] and glioneuronal tumours like ganglioglioma and dysembryoplastic neuroepithelial tumour [28,44,62,73,88,89,91,94,95]; but including oligodendroglioma [77,96,97], cortical ependymoma [98], medulloblastoma [47], subependymal giant cell astrocytoma (SEGA) [99], meningioma [10] 0 , thalamic and cerebellar glioma [38,46], and a variety of atypical, systemic and metastatic tumours, like primary meningeal osteosarcoma [84], acute lymphoblastic leukemia [101], anaplastic large cell lymphoma [102], neuroblastoma [103], melanoma [104], various sarcomas [105,106], Ewing's sarcoma [107], malignant germ cell tumours [108], and others [16,109].…”

Section: How Seizures Presentmentioning

confidence: 99%

“…From the reverse perspective, somewhere between 10 and 50% of brain tumours present with seizures as a symptom [69,74,[81][82][83], and sometimes as the only symptom [32,41,[84][85][86], with supratentorial and especially temporal lesions the most likely to be epileptogenic [44,66,78,[86][87][88]. In one study that compared children with supra-and infratentorial tumours, for example, among those with supratentorial lesions, 42% experienced vomiting as their first symptom, followed by seizures in 37%, and headache in 31% [43].…”

Section: How Seizures Presentmentioning

confidence: 99%

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Temporal lobe gangliogliomas associated with chronic epilepsy: Long-term surgical outcomes

Cited by 17 publications

References 21 publications

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

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

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

Ganglioglioma

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