Early and late epilepsy surgery in focal epilepsies associated with long-term epilepsy-associated tumors

Restricted access

OBJECTIVE

Epilepsy surgery is an effective means of treating focal epilepsy associated with long-term epilepsy-associated tumors. This study evaluated a large population of surgically treated patients with childhood onset of epilepsy and a histologically confirmed diagnosis of long-term epilepsy-associated tumors. The authors analyzed long-term seizure outcomes to establish whether the time of surgery and patients' ages were determinant factors.

METHODS

The authors separately investigated several presurgical, surgical, and postsurgical variables in patients operated on before (pediatric group) and at or after (adult group) the age of 18 years. Patients with < 24 months of postsurgical follow-up were excluded from the analysis.

RESULTS

The patients who underwent surgery before 18 years of age showed better seizure outcomes than those after 18 years of age (80% vs 53.3% Engel Class Ia outcome, respectively; p < 0.001). Multivariate analysis showed that the only variables significantly associated with seizure freedom were complete resection of the lesion, a shorter duration of epilepsy, and temporal lobe resection.

CONCLUSIONS

The findings of this study indicate that pediatric patients are more responsive to epilepsy surgery and that a shorter duration of epilepsy, complete resection, and a temporal lobe localization are determinant factors for a positive seizure outcome.

ABBREVIATIONS AED = antiepileptic drug; DNT = dysembryoplastic neuroepithelial tumor; EEG = electroencephalography; IQR = interquartile range; LEAT = long-term epilepsy-associated tumor; V-EEG = video EEG.
Article Information

Contributor Notes

Correspondence Veronica Pelliccia, Claudio Munari Epilepsy Surgery Centre, Niguarda Hospital, Piazza Ospedale Maggiore 3, Milan 20162, Italy. email: veronica.pelliccia@ospedaleniguarda.it.INCLUDE WHEN CITING Published online January 13, 2017; DOI: 10.3171/2016.9.JNS161176.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© Copyright 1944-2019 American Association of Neurological Surgeons

Headings
References
  • 1

    Aronica ECrino PB: Epilepsy related to developmental tumors and malformations of cortical development. Neurotherapeutics 11:2512682014

  • 2

    Aronica ELeenstra Svan Veelen CWvan Rijen PCHulsebos TJTersmette AC: Glioneuronal tumors and medically intractable epilepsy: a clinical study with long-term follow-up of seizure outcome after surgery. Epilepsy Res 43:1791912001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Bilginer BYalnizoglu DSoylemezoglu FTuranli GCila ATopçu M: Surgery for epilepsy in children with dysembryoplastic neuroepithelial tumor: clinical spectrum, seizure outcome, neuroradiology, and pathology. Childs Nerv Syst 25:4854912009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Blumcke IAronica EUrbach HAlexopoulos AGonzalez-Martinez JA: A neuropathology-based approach to epilepsy surgery in brain tumors and proposal for a new terminology use for long-term epilepsy-associated brain tumors. Acta Neuropathol 128:39542014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Blumcke IRusso GLNajm IPalmini A: Pathology-based approach to epilepsy surgery. Acta Neuropathol 128:132014

  • 6

    Blümcke IWiestler OD: Gangliogliomas: an intriguing tumor entity associated with focal epilepsies. J Neuropathol Exp Neurol 61:5755842002

  • 7

    Bourgeois MDi Rocco FSainte-Rose C: Lesionectomy in the pediatric age. Childs Nerv Syst 22:9319352006

  • 8

    Cardinale FCossu MCastana LCasaceli GSchiariti MPMiserocchi A: Stereoelectroencephalography: surgical methodology, safety, and stereotactic application accuracy in 500 procedures. Neurosurgery 72:3533662013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Cataltepe OTuranli GYalnizoglu DTopçu MAkalan N: Surgical management of temporal lobe tumor-related epilepsy in children. J Neurosurg 102:3 Suppl2802872005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Chan CHBittar RGDavis GAKalnins RMFabinyi GC: Long-term seizure outcome following surgery for dysembryoplastic neuroepithelial tumor. J Neurosurg 104:62692006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Chang EFChristie CSullivan JEGarcia PATihan TGupta N: Seizure control outcomes after resection of dysembryoplastic neuroepithelial tumor in 50 patients. J Neurosurg Pediatr 5:1231302010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Chang EFGabriel RAPotts MBGarcia PABarbaro NMLawton MT: Seizure characteristics and control after microsurgical resection of supratentorial cerebral cavernous malformations. Neurosurgery 65:31382009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Chang EFWang DDBarkovich AJTihan TAuguste KISullivan JE: Predictors of seizure freedom after surgery for malformations of cortical development. Ann Neurol 70:1511622011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Clusmann HKral TGleissner USassen RUrbach HBlümcke I: Analysis of different types of resection for pediatric patients with temporal lobe epilepsy. Neurosurgery 54:8478602004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Cossu MFuschillo DBramerio MGalli CGozzo FPelliccia V: Epilepsy surgery of focal cortical dysplasia-associated tumors. Epilepsia 54:54 Suppl 91151222013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Cossu MLo Russo GFrancione SMai RNobili LSartori I: Epilepsy surgery in children: results and predictors of outcome on seizures. Epilepsia 49:65722008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Engel J JrVan Ness PCRasmussen TBOjemann LMOutcome with respect to epileptic seizures. Engel J Jr: Surgical Treatment of the Epilepsies ed 2.New YorkRaven Press1993. 609621

    • Search Google Scholar
    • Export Citation
  • 18

    Englot DJBerger MSBarbaro NMChang EF: Factors associated with seizure freedom in the surgical resection of glioneuronal tumors. Epilepsia 53:51572012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Englot DJBerger MSBarbaro NMChang EF: Predictors of seizure freedom after resection of supratentorial low-grade gliomas. A review. J Neurosurg 115:2402442011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Gaggero RConsales AFazzini FMancardi MMBaglietto MGNozza P: Epilepsy associated with supratentorial brain tumors under 3 years of life. Epilepsy Res 87:1841892009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Gilliam FWyllie EKashden JFaught EKotagal PBebin M: Epilepsy surgery outcome: comprehensive assessment in children. Neurology 48:136813741997

  • 22

    Giulioni MGalassi EZucchelli MVolpi L: Seizure outcome of lesionectomy in glioneuronal tumors associated with epilepsy in children. J Neurosurg 102:3 Suppl2882932005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Giulioni MGardella ERubboli GRoncaroli FZucchelli MBernardi B: Lesionectomy in epileptogenic gangliogliomas: seizure outcome and surgical results. J Clin Neurosci 13:5295352006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Giulioni MMarucci GMartinoni MMarliani AFToni FBartiromo F: Epilepsy associated tumors: Review article. World J Clin Cases 2:6236412014

  • 25

    Kilpatrick CCook MMatkovic ZO'Brien TKaye AMurphy M: Seizure frequency and duration of epilepsy are not risk factors for postoperative seizure outcome in patients with hippocampal sclerosis. Epilepsia 40:8999031999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Kim NRWang KCBang JSChoe GPark YKim SK: Glioblastomatous transformation of ganglioglioma: case report with reference to molecular genetic and flow cytometric analysis. Pathol Int 53:8748822003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Kim SKWang KCHwang YSKim KJChae JHKim IO: Epilepsy surgery in children: outcomes and complications. J Neurosurg Pediatr 1:2772832008

  • 28

    Kleihues PSobin LH: World Health Organization classification of tumors. Cancer 88:28872000

  • 29

    Lang FFEpstein FJRansohoff JAllen JCWisoff JAbbott IR: Central nervous system gangliogliomas. Part 2: Clinical outcome. J Neurosurg 79:8678731993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Lowe NMEldridge PVarma TWieshmann UC: The duration of temporal lobe epilepsy and seizure outcome after epilepsy surgery. Seizure 19:2612632010

  • 31

    Luyken CBlümcke IFimmers RUrbach HElger CEWiestler OD: The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 44:8228302003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Minkin KKlein OMancini JLena G: Surgical strategies and seizure control in pediatric patients with dysembryoplastic neuroepithelial tumors: a single-institution experience. J Neurosurg Pediatr 1:2062102008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Nolan MASakuta RChuang NOtsubo HRutka JTSnead OC III: Dysembryoplastic neuroepithelial tumors in childhood: long-term outcome and prognostic features. Neurology 62:227022762004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Radhakrishnan AAbraham MRadhakrishnan VVSarma SPRadhakrishnan K: Medically refractory epilepsy associated with temporal lobe ganglioglioma: characteristics and postoperative outcome. Clin Neurol Neurosurg 108:6486542006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Ramantani GKadish NEAnastasopoulos CBrandt AWagner KStrobl K: Epilepsy surgery for glioneuronal tumors in childhood: avoid loss of time. Neurosurgery 74:6486572014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Sakuta ROtsubo HNolan MAWeiss SKHawkins CRutka JT: Recurrent intractable seizures in children with cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumor. J Child Neurol 20:3773842005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Thom MBlümcke IAronica E: Long-term epilepsy-associated tumors. Brain Pathol 22:3503792012

  • 38

    Wiebe SBlume WTGirvin JPEliasziw M: A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345:3113182001

  • 39

    Yang IChang EFHan SJBarry JJFang STihan T: Early surgical intervention in adult patients with ganglioglioma is associated with improved clinical seizure outcomes. J Clin Neurosci 18:29332011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 185 185 21
Full Text Views 318 232 2
PDF Downloads 231 132 3
EPUB Downloads 0 0 0
PubMed
Google Scholar