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

Restricted access

OBJECTIVE

The 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).

METHODS

A 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.

RESULTS

A 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.

CONCLUSIONS

Gross-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.

ABBREVIATIONS AED = antiepileptic drug; ECoG = electrocorticography; GTR = gross-total resection; HR = hazard ratio; PFS = progression-free survival; STR = subtotal resection.

Article Information

Correspondence Guillermo Aldave: Texas Children’s Hospital, Baylor College of Medicine, Houston, TX. gxaldave@texaschildrens.org.

INCLUDE WHEN CITING Published online March 22, 2019; DOI: 10.3171/2019.1.PEDS18367.

Disclosures Dr. Curry is a consultant for Medtronic, Inc., and Monteris, Inc.

© AANS, except where prohibited by US copyright law.

Headings

Figures

References

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 67 67 37
Full Text Views 28 28 19
PDF Downloads 14 14 11
EPUB Downloads 0 0 0

PubMed

Google Scholar