Surgery for insular low-grade glioma: predictors of postoperative seizure outcome

Clinical article

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  • 1 Departments of Neurosurgery and
  • 3 Neurology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine;
  • 2 Robotics, Brain and Cognitive Sciences Department, Italian Institute of Technology, Genoa;
  • 4 Section of Statistics, University of Udine and
  • 5 Institute of Hygiene and Clinical Epidemiology, Department of Medical and Biological Sciences, University of Udine; and
  • 6 Section of Human Physiology, University of Ferrara, Italy
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Object

Although a number of recent studies on the surgical treatment of insular low-grade glioma (LGG) have demonstrated that aggressive resection leads to increased overall patient survival and decreased malignant progression, less attention has been given to the results with respect to tumor-related epilepsy. The aim of this investigation was to evaluate the impact of volumetric, histological, and intraoperative neurophysiological factors on seizure outcome in patients with insular LGG.

Methods

The authors evaluated predictors of seizure outcome with special emphasis on both the extent of tumor resection (EOR) and the tumor's infiltrative pattern quantified by computing the difference between the preoperative T2- and T1-weighted MR images (ΔVT2T1) in 52 patients with preoperative drug-resistant epilepsy.

Results

The 12-month postoperative seizure outcome (Engel class) was as follows: seizure free (Class I), 67.31%; rare seizures (Class II), 7.69%; meaningful seizure improvement (Class III), 15.38%; and no improvement or worsening (Class IV), 9.62%. Poor seizure control was more common in patients with a longer preoperative seizure history (p < 0.002) and higher frequency of seizures (p = 0.008). Better seizure control was achieved in cases with EOR ≥ 90% (p < 0.001) and ΔVT2T1 < 30 cm3 (p < 0.001). In the final model, ΔVT2T1 proved to be the strongest independent predictor of seizure outcome in insular LGG patients (p < 0.0001).

Conclusions

No or little postoperative seizure improvement occurs mainly in cases with a prevalent infiltrative tumor growth pattern, expressed by high ΔVT2T1 values, which consequently reflects a smaller EOR.

Abbreviations used in this paper:AED = antiepileptic drug; ECoG = electrocorticography; EEG = electroencephalography; EOR = extent of resection; ILAE = International League Against Epilepsy; LGG = low-grade glioma; ΔVT2T1 = difference between preoperative tumor volumes on T2- and T1-weighted MRI.

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Contributor Notes

Address correspondence to: Tamara Ius, M.D., Department of Neurosurgery, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine 33100, Italy. email: tamara.ius@gmail.com.

Please include this information when citing this paper: published online November 15, 2013; DOI: 10.3171/2013.9.JNS13728.

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