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Vysakha KV, Jain K, Nandana J, Manisha KY, Menon RN, Vilanilam G, Abraham M, Thomas B, Kesavadas C, Radhakrishnan A. Do we have to continue antiseizure medications post surgery in long-term epilepsy associated tumors (LEATs)? Clin Neurol Neurosurg 2024; 244:108433. [PMID: 38991393 DOI: 10.1016/j.clineuro.2024.108433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To identify the rate of successful antiseizure medication (ASM) withdrawal after resective surgery in patients with long-term epilepsy-associated tumors (LEATs). METHODS A retrospective analysis (from our prospectively archived data) on the post-operative ASM profile of 123 consecutive patients who completed a minimum of 2 years after resection of LEATs for ASM-resistant epilepsy. A comparison between recurred and non-recurred groups in terms of seizure recurrence was used to identify the potential predictors of seizure recurrence whose attributes were further analyzed using univariate and multiple logistic regression analysis. Kaplan-Meier survival curves were used to study the probability of ASM freedom following surgery. RESULTS We attempted ASM withdrawal in 102 (82.9 %) patients. Forty-eight (47.1 %) had seizure recurrence while reducing ASM, of which 22 (21.6 %) continued to have seizures even after ASM optimisation. On univariate analysis, presence of pre-operative secondary generalized seizure(s) was the only factor associated with seizure recurrence. At a mean follow-up of 6.1 years, 72 (58.5 %) patients were seizure-free and aura-free at terminal follow-up (53 patients were off any ASM). The cumulative probability of achieving complete ASM-free status was 29 % at fourth year, 42 % at sixth year, 55 % at eighth year, and 59 % at 10th year after surgery. CONCLUSIONS Following resective surgery for LEATs, ASM(s) could be successfully discontinued in half of the patients. About one-third of the patients may have recurrent seizures on follow-up. Presence of secondary generalized seizure(s) prior to surgery predicts seizure recurrence, whereas MRI defined completeness of resection will not. This information will help in rationalising decisions on ASM management post-resection.
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Affiliation(s)
- Kavadisseril Vivekanandan Vysakha
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Kshiteeja Jain
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Jayakumari Nandana
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Karamala Yalapalli Manisha
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Ramshekhar N Menon
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - George Vilanilam
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Mathew Abraham
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Bejoy Thomas
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Chandrashekharan Kesavadas
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Ashalatha Radhakrishnan
- R. Madhavan Nayar Centre for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India.
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Nandoliya KR, Thirunavu V, Ellis E, Dixit K, Tate MC, Drumm MR, Templer JW. Pre-operative predictors of post-operative seizure control in low-grade glioma: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:94. [PMID: 38411788 DOI: 10.1007/s10143-024-02329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
As many as 80% of low-grade gliomas (LGGs) present with seizures, negatively impacting quality of life. While seizures are associated with gliomas regardless of grade, the importance of minimizing impact of seizures for patients with low grade tumors cannot be understated given the prolonged survival period in this population. The objective of this systematic review and meta-analysis was to summarize existing literature and identify factors associated with post-operative seizure control (defined as Engel I classification) in patients with LGGs, with a focus on pre-operative factors. Patient data extracted include tumor location and histology, pre-operative anti-seizure medication use, extent of resection (EOR), adjuvant treatment, pre-operative seizure type, duration, and frequency, and post-operative Engel classification. A random-effects model was used to calculate the effects of EOR, pre-operative seizure duration, adjuvant radiation, and adjuvant chemotherapy on post-operative seizure control. The effect of tumor location and histology on post-operative Engel I classification was determined using contingency analyses. Thirteen studies including 1628 patients with seizures were included in the systematic review. On meta-analyses, Engel I classification was associated with pre-operative seizure type (OR = 0.79 (0.63-0.99), p = 0.0385, focal versus generalized), frontal lobe LGGs (OR = 1.5 (1.1-2.0), p = 0.0195), and EOR (OR (95% CI) = 4.5 (2.3-6.7), p < 0.0001 gross-total versus subtotal). Pre-operative seizure duration less than one year, adjuvant radiation, adjuvant chemotherapy, and tumor histology were not associated with achieving Engel I classification. In addition to the known effects of EOR, Engel I classification is less likely to be achieved in patients with focal pre-operative seizures and more likely to be achieved in patients with frontal lobe LGGs.
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Affiliation(s)
- Khizar R Nandoliya
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Erin Ellis
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Karan Dixit
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA
| | - Matthew C Tate
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Michael R Drumm
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jessica W Templer
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA.
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Saviuk M, Sleptsova E, Redkin T, Turubanova V. Unexplained Causes of Glioma-Associated Epilepsies: A Review of Theories and an Area for Research. Cancers (Basel) 2023; 15:5539. [PMID: 38067243 PMCID: PMC10705208 DOI: 10.3390/cancers15235539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023] Open
Abstract
Approximately 30% of glioma patients are able to survive beyond one year postdiagnosis. And this short time is often overshadowed by glioma-associated epilepsy. This condition severely impairs the patient's quality of life and causes great suffering. The genetic, molecular and cellular mechanisms underlying tumour development and epileptogenesis remain incompletely understood, leading to numerous unanswered questions. The various types of gliomas, namely glioblastoma, astrocytoma and oligodendroglioma, demonstrate distinct seizure susceptibility and disease progression patterns. Patterns have been identified in the presence of IDH mutations and epilepsy, with tumour location in cortical regions, particularly the frontal lobe, showing a more frequent association with seizures. Altered expression of TP53, MGMT and VIM is frequently detected in tumour cells from individuals with epilepsy associated with glioma. However, understanding the pathogenesis of these modifications poses a challenge. Moreover, hypoxic effects induced by glioma and associated with the HIF-1a factor may have a significant impact on epileptogenesis, potentially resulting in epileptiform activity within neuronal networks. We additionally hypothesise about how the tumour may affect the functioning of neuronal ion channels and contribute to disruptions in the blood-brain barrier resulting in spontaneous depolarisations.
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Affiliation(s)
- Mariia Saviuk
- Institute of Neurosciences, National Research Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603022 Nizhny Novgorod, Russia; (M.S.); (E.S.); (T.R.)
- Cell Death Investigation and Therapy Laboratory, Anatomy and Embryology Unit, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Ekaterina Sleptsova
- Institute of Neurosciences, National Research Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603022 Nizhny Novgorod, Russia; (M.S.); (E.S.); (T.R.)
| | - Tikhon Redkin
- Institute of Neurosciences, National Research Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603022 Nizhny Novgorod, Russia; (M.S.); (E.S.); (T.R.)
| | - Victoria Turubanova
- Institute of Neurosciences, National Research Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603022 Nizhny Novgorod, Russia; (M.S.); (E.S.); (T.R.)
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Chávez López EK, Aparicio J, Valera C, Campistol Plana J, Ramírez Camacho A, Fons C, Arzimanoglou A. Pre-surgical evaluation challenges and long-term outcome in children operated on for Low Grade Epilepsy Associated brain Tumors. Eur J Paediatr Neurol 2022; 41:55-62. [PMID: 36272355 DOI: 10.1016/j.ejpn.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 04/10/2022] [Accepted: 10/09/2022] [Indexed: 12/01/2022]
Abstract
OBJETIVE Analyze pre-surgical evaluation modalities, surgical failures, long-term results of surgery and neurocognitive outcome in children with Low-grade Epilepsy Associated brain Tumors (LEAT). METHODS Retrospective observational study of 37 children who underwent epilepsy surgery, with a minimum follow-up of 12 months. At time of surgery, pharmaco-sensitivity (Group 1; n = 8) and drug-resistance (Group 2; n = 29), were considered. RESULTS Age range of seizure onset was 5 months-14 years (mean 5.73years) and age at surgery was 2.2-18.7years (mean 10.7years). Gangliogliomas (35.1%) or DNTs (29.7%), combined or not to a focal cortical dysplasia (FCD), were the most frequent. Extended lesionectomy 16 children (43.2%) were the most frequently used surgical approach in both groups. At one year of follow-up, 36 children (97.2%) were classified as Engel I. Within the age-range studied, duration of epilepsy and time to surgery appeared to have no impact on clinical and neurocognitive outcome in both groups. It is noteworthy, however, that antiseizure medications (ASMs) were withdrawn in 100% of the pharmacosensitive group vs 34.5% of the drug-resistant group (p = 0.002). In children with a pharmaco-sensitive epilepsy, neurocognitive evaluation showed significant improvement in the verbal comprehension index (p = 0.029). CONCLUSIONS Epilepsy-surgery is a safe therapeutic option for LEATs including for children with seizures controlled by ASMs. Presence of associated lesions is not rare. Comprehensive pre-surgical evaluation increases the chances for control of the seizures, the early discontinuation of medications and favours neurocognitive development.
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Affiliation(s)
- Evelyn Karina Chávez López
- Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain.
| | - Javier Aparicio
- Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
| | - Carlos Valera
- Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
| | - Jaume Campistol Plana
- Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
| | - Alia Ramírez Camacho
- Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
| | - Carmen Fons
- Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain
| | - Alexis Arzimanoglou
- Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain; Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Member of ERN-EpiCARE, University Hospitals of Lyon (HCL), Lyon, France
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Zheng Z, Jiang H, Wu H, Ding Y, Wang S, Ming W, Zhu J. Epilepsy surgery for low-grade epilepsy-associated neuroepithelial tumor of temporal lobe: a single-institution experience of 61 patients. Neurol Sci 2021; 43:3333-3341. [PMID: 34816317 PMCID: PMC9018634 DOI: 10.1007/s10072-021-05703-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Abstract
Background Low-grade epilepsy-associated neuroepithelial tumor (LEAT) is highly responsive to surgery in general. The appropriate surgical strategy remains controversial in temporal LEAT. The aim of this study is to analyze the surgical seizure outcome of temporal LEAT, focusing on the aspects of surgical strategy. Methods Sixty-one patients from a single epilepsy center with temporal LEAT underwent surgery. The surgical strategy was according to the multidisciplinary presurgical evaluation. Electrocorticogram (ECoG)-assisted resection was utilized. Surgical extent including lesionectomy and extended resection was described in detail. Seizure outcome was classified as satisfactory (Engel class I) and unsatisfactory (Engel classes II–IV). Results After a median follow-up of 36.0 (30.0) months, 83.6% of patients achieved satisfactory outcome, including 72.1% with Engel class Ia. There was 39.3% (24/61) of patients with antiepileptic drug (AED) withdrawal. Use of ECoG (χ2 = 0.000, P > 0.1), preresection spike (χ2 = 0.000, P = 0.763), or spike residue (P = 0.545) was not correlated with the seizure outcome. For lateral temporal LEAT, outcome from lesionectomy was comparable to extended resection (χ2 = 0.499, P > 0.1). For mesial temporal LEAT, 94.7% (18/19) of patients who underwent additional hippocampectomy were satisfactory, whereas only 25% (1/4) of patients who underwent lesionectomy were satisfactory (P = 0.009). Conclusion Surgical treatment was highly effective for temporal LEAT. ECoG may not influence the seizure outcome. For lateral temporal LEAT, lesionectomy with or without cortectomy was sufficient in most patients. For mesial temporal LEAT, extended resection was recommended.
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Affiliation(s)
- Zhe Zheng
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurosurgery The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Hongjie Jiang
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurosurgery The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Hemmings Wu
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurosurgery The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Yao Ding
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Shuang Wang
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Wenjie Ming
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China
| | - Junming Zhu
- Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China.
- Department of Neurosurgery The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangchen District, Hangzhou, 310009, China.
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Jain M, Panda A, Patel B, Ajay SC. Anaesthesia workstation monitor: why surgeons should monitor? BMJ Case Rep 2021; 14:e244932. [PMID: 34380691 PMCID: PMC8359526 DOI: 10.1136/bcr-2021-244932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mantu Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Aparajita Panda
- Anaesthesia, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Barun Patel
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Ssamy C Ajay
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
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Höhne J, Acerbi F, Falco J, Akçakaya MO, Schmidt NO, Kiris T, de Laurentis C, Ferroli P, Broggi M, Schebesch KM. Lighting Up the Tumor-Fluorescein-Guided Resection of Gangliogliomas. J Clin Med 2020; 9:jcm9082405. [PMID: 32731376 PMCID: PMC7465830 DOI: 10.3390/jcm9082405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/13/2023] Open
Abstract
(1) Background: Gangliogliomas comprise a small number of brain tumors. They usually present as World Health Organization (WHO) grade I, and they delineate on gadolinium-enhanced MRI; the surgical goal is wide radical resection, and the course thereafter is usually benign. Fluorescein sodium (FL) tends to accumulate in areas with altered blood–brain barrier (BBB). Thus far, the results provided by prospective and retrospective studies show that the utilization of this fluorophore may be associated with better visualization and improvement of resection for several tumors of the central nervous system. In this study, we retrospectively studied the effect of fluorescein sodium on visualization and resection of gangliogliomas. (2) Methods: Surgical databases in three neurosurgical departments (Regensburg University Hospital; Besta Institute, Milano, Italy; and Liv Hospital, Istanbul, Turkey), with approval by the local ethics committee, were retrospectively reviewed to find gangliogliomas surgically removed by a fluorescein-guided technique by the aid of a dedicated filter on the surgical microscope from April 2014 to February 2020. Eighteen patients (13 women, 5 men; mean age 22.9 years, range 3 to 78 years) underwent surgical treatment for gangliogliomas during 19 operations. Fluorescein was intravenously injected (5 mg/kg) after general anesthesia induction. Tumors were removed using a microsurgical technique with the YELLOW 560 Filter (YE560) (KINEVO/PENTERO 900, Carl Zeiss Meditec, Oberkochen, Germany). (3) Results: No side effects related to fluorescein occurred. In all tumors, contrast enhancement on preoperative MRI correlated with bright yellow fluorescence during the surgical procedure (17 gangliogliomas WHO grade I, 1 ganglioglioma WHO grade II). Fluorescein was considered helpful by the operating surgeon in distinguishing tumors from viable tissue in all cases (100%). Biopsy was intended in two operations, and subtotal resection was intended in one operation. In all other operations considered preoperatively eligible, gross total resection (GTR) was achieved in 12 out of 16 (75%) instances. (4) Conclusions: The use of FL and YE560 is a readily available method for safe fluorescence-guided tumor resection, possibly visualizing tumor margins intraoperatively similar to contrast enhancement in T1-weighted MRI. Our data suggested a positive effect of fluorescein-guided surgery on intraoperative visualization and extent of resection during resection of gangliogliomas.
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Affiliation(s)
- Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (N.O.S.); (K.-M.S.)
- Correspondence: ; Tel.: +49-941-944-19007
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Mehmet Osman Akçakaya
- Department of Neurosurgery Liv Hospital Ulus Affiliated with Istinye University Medical Faculty, Istanbul 34340, Turkey; (M.O.A.); (T.K.)
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (N.O.S.); (K.-M.S.)
| | - Talat Kiris
- Department of Neurosurgery Liv Hospital Ulus Affiliated with Istinye University Medical Faculty, Istanbul 34340, Turkey; (M.O.A.); (T.K.)
| | - Camilla de Laurentis
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy; (F.A.); (J.F.); (C.d.L.); (P.F.); (M.B.)
| | - Karl-Michael Schebesch
- Department of Neurosurgery, University Medical Center Regensburg, 93053 Regensburg, Germany; (N.O.S.); (K.-M.S.)
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Fan Y, Yu J, Chen H, Zhang J, Duan J, Mo D, Zhu W, Wang B, Ouyang F, Chen Y, Lan L, Zeng J. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis. Stroke Vasc Neurol 2020; 5:152-158. [PMID: 32409571 PMCID: PMC7337369 DOI: 10.1136/svn-2020-000358] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
Aim Cerebral venous sinus thrombosis (CVST) is a less common cerebrovascular disease that predominantly affects young patients. The incidence of CVST is 2–5/10 000 000/year, accounting for 0.5%–1% of all stroke. To reduce mortality and morbidity associated with CVST, Chinese Stroke Association commissioned the authors to write the current guideline on the management of CVST. Methods PubMed (MEDLINE), CNKI and Wanfang database were searched for studies related to CVST from 1 January 1990 to 31 July 2019. Data were synthesised by evidence tables. Each recommendation was fully discussed by the writing group members and reviewed by Chinese Stroke Association Stroke Fellow Committees. Levels of evidence grading algorithm of Chinese Stroke Association was used to grade each recommendation. Results This guideline mainly focuses on the diagnostic evaluation, therapeutic strategies and secondary prevention of CVST. CT/CTV and MRI/MRV are recommended in the initial imaging evaluation of patients with suspected CVST. Anticoagulation therapy with low-molecular weight heparin should be initiated in patients with CVST immediately. After the acute stage, warfarin is recommended for 3–6 months to prevent the recurrence of CVST and other venous thromboembolic events. Conclusions The guideline summarises the current evidence regarding the management of CVST, and provides references for diagnosis, treatment and secondary prevention of CVST in China.
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Affiliation(s)
- Yuhua Fan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Yu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Hongbing Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jiangang Duan
- Department of Neurology and Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhao Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Wang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fubing Ouyang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yicong Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Linfang Lan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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Blümcke I, Coras R, Wefers AK, Capper D, Aronica E, Becker A, Honavar M, Stone TJ, Jacques TS, Miyata H, Mühlebner A, Pimentel J, Söylemezoğlu F, Thom M. Review: Challenges in the histopathological classification of ganglioglioma and DNT: microscopic agreement studies and a preliminary genotype-phenotype analysis. Neuropathol Appl Neurobiol 2018; 45:95-107. [PMID: 30326153 DOI: 10.1111/nan.12522] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/03/2018] [Indexed: 12/28/2022]
Abstract
Low-grade epilepsy-associated brain tumours (LEAT) are the second most common cause for drug-resistant, focal epilepsy, that is ganglioglioma (GG) and dysembryoplastic neuroepithelial tumours (DNT). However, molecular pathogenesis, risk factors for malignant progression and their frequent association with drug-resistant focal seizures remain poorly understood. This contrasts recent progress in understanding the molecular-genetic basis and targeted treatment options in diffuse gliomas. The Neuropathology Task Force of the International League Against Epilepsy examined available literature to identify common obstacles in diagnosis and research of LEAT. Analysis of 10 published tumour series from epilepsy surgery pointed to poor inter-rater agreement for the histopathology diagnosis. The Task Force tested this hypothesis using a web-based microscopy agreement study. In a series of 30 LEAT, 25 raters from 18 countries agreed in only 40% of cases. Highest discordance in microscopic diagnosis occurred between GG and DNT variants, when oligodendroglial-like cell patterns prevail, or ganglion cells were difficult to discriminate from pre-existing neurons. Suggesting new terminology or major histopathological criteria did not satisfactorily increase the yield of histopathology agreement in four consecutive trials. To this end, the Task Force applied the WHO 2016 strategy of integrating phenotype analysis with molecular-genetic data obtained from panel sequencing and 450k methylation arrays. This strategy was helpful to distinguish DNT from GG variants in all cases. The Task Force recommends, therefore, to further develop diagnostic panels for the integration of phenotype-genotype analysis in order to reliably classify the spectrum of LEAT, carefully characterize clinically meaningful entities and make better use of published literature.
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Affiliation(s)
- I Blümcke
- Department of Neuropathology, University Hospital, Erlangen, Germany.,Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - R Coras
- Department of Neuropathology, University Hospital, Erlangen, Germany
| | - A K Wefers
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - D Capper
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Institute of Neuropathology, Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - E Aronica
- Department of (Neuro)Pathology, Academic Medisch Centrum (AMC), Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - A Becker
- Department of Neuropathology, University of Bonn Medical Centre, Bonn, Germany
| | - M Honavar
- Department of Anatomic Pathology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - T J Stone
- Developmental Biology and Cancer Section, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - T S Jacques
- Developmental Biology and Cancer Section, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - H Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels -AKITA, Akita, Japan
| | - A Mühlebner
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - J Pimentel
- Laboratory of Neuropathology, Department of Neurology, Hospital de Santa Maria (CHLN), Lisbon, Portugal
| | - F Söylemezoğlu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - M Thom
- Department of Clinical and Experimental Epilepsy UCL Queens Square, Institute of Neurology, London
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10
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Vogt VL, Witt JA, Delev D, Grote A, von Lehe M, Becker AJ, Schramm J, Elger CE, Helmstaedter C. Cognitive features and surgical outcome of patients with long-term epilepsy-associated tumors (LEATs) within the temporal lobe. Epilepsy Behav 2018; 88:25-32. [PMID: 30212725 DOI: 10.1016/j.yebeh.2018.08.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate cognitive and epilepsy-related features in 166 surgically treated patients with epilepsy with long-term epilepsy-associated tumors (LEATs) located in the temporal lobe. METHOD Pre- and postsurgical cognitive as well as the one-year seizure outcome of adult patients with histopathologically confirmed LEATs (28 grade-I dysembryoplastic neuroepithelial tumors (DNET), 95 grade-I gangliogliomas (GG), 24 grade-I pilocytic astrocytomas (PA), 9 grade-II pleomorphic xanthoastrocytoma (PXA), 10 grade-II diffuse astrocytoma (DA)) who underwent epilepsy surgery in Bonn/Germany between 1988 and 2012 were evaluated. RESULTS At baseline, tumor groups differed in regard to age at epilepsy onset and location within the temporal lobe. Postoperative seizure freedom was achieved most frequently (>77.8%) in DNET, GG, and DA, less often in PXA (62.5%) and the least in PA (56.5%). Preoperative memory was impaired in 67.1% of all patients, executive functions in 44.7%, and language in 45.5%. Patients with PA displayed the poorest cognitive performance. Individual significant memory decline that was observed in 27.1% of all patients was predicted by left-sided surgery, a mesial pathology, and extended hippocampal resection. Executive functions depended on antiepileptic drug (AED) load and remained stable (72.0%) or even improved (21.6%) after surgery. Language functions were unchanged in 89.5% of patients. CONCLUSION Patients with LEATs in the temporal lobe frequently show cognitive impairments. Predictors for pre- and postoperative cognition mostly correspond to what is known for temporal lobe epilepsy and resections in general. However, different tumor types appear to be associated with different cognitive and seizure outcomes with astrocytoma as the least benefitted group.
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Affiliation(s)
- Viola L Vogt
- Dept. of Epileptology, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
| | - Juri-Alexander Witt
- Dept. of Epileptology, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Daniel Delev
- Dept. of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Alexander Grote
- Dept. of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Marec von Lehe
- Dept. of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Albert J Becker
- Dept. of Neuropathology, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Johannes Schramm
- Dept. of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Christian E Elger
- Dept. of Epileptology, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Christoph Helmstaedter
- Dept. of Epileptology, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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11
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Corley JA, Nazari P, Rossi VJ, Kim NC, Fogg LF, Hoeppner TJ, Stoub TR, Byrne RW. Cortical stimulation parameters for functional mapping. Seizure 2016; 45:36-41. [PMID: 27914225 DOI: 10.1016/j.seizure.2016.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/11/2016] [Accepted: 11/17/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE There is significant variation in how patients respond to cortical electrical stimulation. It has been hypothesized that individual demographic and pathologic factors, such as age, sex, disease duration, and MRI findings, may explain this discrepancy. The purpose of our study is to identify specific patient characteristics and their effect on cortical stimulation, and discover the extent of variation in behavioral responses that exists among patients with epilepsy. METHOD We retrospectively analyzed data from 92 patients with medically intractable epilepsy who had extra-operative cortical electrical stimulation. Mapping records were evaluated and information gathered about demographic data, as well as the thresholds of stimulation for motor, sensory, speech, and other responses; typical seizure behavior; and the induction of afterdischarges. RESULTS Ninety-two patient cortical stimulation mapping reports were analyzed. The average of the minimum thresholds for motor response was 4.15mA±2.67. The average of the minimum thresholds for sensory response was 3.50mA±2.15. The average of the minimum thresholds for speech response was 4.48mA±2.42. The average of the minimum thresholds for afterdischarge was 4.33mA±2.37. Most striking were the degree of variability and wide range of thresholds seen between patients and within the different regions of the same patient. CONCLUSION Wide ranges of thresholds exist for the different responses between patients and within different regions of the same patient. With multivariate analysis in these series, no clinical or demographic factors predicted physiological response or afterdischarge threshold levels.
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Affiliation(s)
- Jacquelyn A Corley
- Department of Neurosurgery, Duke University Hospital, DUMC Box 3807, Durham, NC 27710, United States.
| | - Pouya Nazari
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Vincent J Rossi
- Department of Neurological Surgery, Carolinas Medical Center, Charlotte, NC 28203, United States
| | - Nora C Kim
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Louis F Fogg
- College of Nursing, Rush University, Chicago, IL 60612, United States
| | - Thomas J Hoeppner
- Department of Neurological Sciences, Rush University, Chicago, IL 60612, United States
| | - Travis R Stoub
- Department of Neurological Sciences, Rush University, Chicago, IL 60612, United States
| | - Richard W Byrne
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, United States
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12
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Roessler K, Hofmann A, Sommer B, Grummich P, Coras R, Kasper BS, Hamer HM, Blumcke I, Stefan H, Nimsky C, Buchfelder M. Resective surgery for medically refractory epilepsy using intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients. Neurosurg Focus 2016; 40:E15. [DOI: 10.3171/2015.12.focus15554] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Intraoperative overestimation of resection volume in epilepsy surgery is a well-known problem that can lead to an unfavorable seizure outcome. Intraoperative MRI (iMRI) combined with neuronavigation may help surgeons avoid this pitfall and facilitate visualization and targeting of sometimes ill-defined heterogeneous lesions or epileptogenic zones and may increase the number of complete resections and improve seizure outcome.
METHODS
To investigate this hypothesis, the authors conducted a retrospective clinical study of consecutive surgical procedures performed during a 10-year period for epilepsy in which they used neuronavigation combined with iMRI and functional imaging (functional MRI for speech and motor areas; diffusion tensor imaging for pyramidal, speech, and visual tracts; and magnetoencephalography and electrocorticography for spike detection). Altogether, there were 415 patients (192 female and 223 male, mean age 37.2 years; 41% left-sided lesions and 84.9% temporal epileptogenic zones). The mean preoperative duration of epilepsy was 17.5 years. The most common epilepsy-associated pathologies included hippocampal sclerosis (n = 146 [35.2%]), long-term epilepsy-associated tumor (LEAT) (n = 67 [16.1%]), cavernoma (n = 45 [10.8%]), focal cortical dysplasia (n = 31 [7.5%]), and epilepsy caused by scar tissue (n = 23 [5.5%]).
RESULTS
In 11.8% (n = 49) of the surgeries, an intraoperative second-look surgery (SLS) after incomplete resection verified by iMRI had to be performed. Of those incomplete resections, LEATs were involved most often (40.8% of intraoperative SLSs, 29.9% of patients with LEAT). In addition, 37.5% (6 of 16) of patients in the diffuse glioma group and 12.9% of the patients with focal cortical dysplasia underwent an SLS. Moreover, iMRI provided additional advantages during implantation of grid, strip, and depth electrodes and enabled intraoperative correction of electrode position in 13.0% (3 of 23) of the cases. Altogether, an excellent seizure outcome (Engel Class I) was found in 72.7% of the patients during a mean follow-up of 36 months (range 3 months to 10.8 years). The greatest likelihood of an Engel Class I outcome was found in patients with cavernoma (83.7%), hippocampal sclerosis (78.8%), and LEAT (75.8%). Operative revisions that resulted from infection occurred in 0.3% of the patients, from hematomas in 1.6%, and from hydrocephalus in 0.8%. Severe visual field defects were found in 5.2% of the patients, aphasia in 5.7%, and hemiparesis in 2.7%, and the total mortality rate was 0%.
CONCLUSIONS
Neuronavigation combined with iMRI was beneficial during surgical procedures for epilepsy and led to favorable seizure outcome with few specific complications. A significantly higher resection volume associated with a higher chance of favorable seizure outcome was found, especially in lesional epilepsy involving LEAT or diffuse glioma.
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Affiliation(s)
| | | | | | | | | | | | - Hajo M. Hamer
- 3Neurology, Epilepsy Centre, University Hospital Erlangen; and
| | | | - Hermann Stefan
- 3Neurology, Epilepsy Centre, University Hospital Erlangen; and
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13
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Surgery for “Long-term epilepsy associated tumors (LEATs)”: Seizure outcome and its predictors. Clin Neurol Neurosurg 2016; 141:98-105. [DOI: 10.1016/j.clineuro.2015.12.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/21/2015] [Accepted: 12/27/2015] [Indexed: 11/23/2022]
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14
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Meguins LC, Adry RARDC, Silva Júnior SCD, Pereira CU, Oliveira JGD, Morais DFD, Araújo Filho GMD, Marques LHN. Gross-total resection of temporal low grade gliomas is a critically important factor in achieving seizure-freedom. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:924-8. [PMID: 26517215 DOI: 10.1590/0004-282x20150141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 07/23/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present a surgical series of patients with low grade temporal gliomas causing intractable epilepsy, focusing on long-term seizure outcome. METHOD A retrospective study was conducted with patients with temporal low-grade gliomas (LGG). RESULTS Sixty five patients with were operated in our institution. Males were more affected than females and the mean age at surgery was 32.3 ± 8.4 (9-68 years). The mean age at seizure onset was 25.7 ± 9.2 (11-66 years). Seizure outcome was classified according with Engel classification. After one year of follow up, forty two patients (64.6%) were Engel I; seventeen (26.2%) Engel II; four (6.2%) Engel III and two (3.1%) Engel IV. Statistically significant difference in seizure outcome was obtained when comparing the extension of resection. Engel I was observed in 39 patients (69.6%) with total resection and in only 3 (33.3%) patients with partial resection. CONCLUSION Gross-total resection of temporal LGGs is a critically important factor in achieving seizure-freedom.
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Affiliation(s)
- Lucas Crociati Meguins
- Departamento de Ciências Neurológica, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Rodrigo Antônio Rocha da Cruz Adry
- Departamento de Ciências Neurológica, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Sebastião Carlos da Silva Júnior
- Departamento de Ciências Neurológica, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | - Jean Gonçalves de Oliveira
- Departamento de Ciências Medicas, Faculdade de Medicina, Universidade Nove de Julho, São Paulo, SP, Brazil
| | - Dionei Freitas de Morais
- Departamento de Ciências Neurológica, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Gerardo Maria de Araújo Filho
- Departamento de Psiquiatria e Medicina Psicológica, Faculdade de Medicina de São José do Rio Preto, São Paulo, SP, Brazil
| | - Lúcia Helena Neves Marques
- Departamento de Ciências Neurológica, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
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15
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Kemerdere R, Yuksel O, Kacira T, Yeni N, Ozkara C, Tanriverdi T, Uzan M, Ozyurt E. Low-grade temporal gliomas: surgical strategy and long-term seizure outcome. Clin Neurol Neurosurg 2014; 126:196-200. [PMID: 25285877 DOI: 10.1016/j.clineuro.2014.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 11/25/2022]
Abstract
Low-grade gliomas (LGGs) are generally located in temporal lobe and cause medically-intractable seizure so that surgical treatment becomes inevitable. This study includes a retrospective analysis of our patients with temporal LGGs retrieved from our epilepsy surgery data base and tries to present appropriate surgical approach and long-term seizure and anti-epileptic drug (AED) outcomes. Fifty-three patients including children and adults underwent surgery on temporal lobe LGGs and 35 patients were reached to report seizure and AED outcomes. On the non-dominant temporal lobe, anterior temporal resection with hippocampectomy whether mesial structure are involved or not is the appropriate approach. On the dominant temporal lobe mesial structures should be respected. However, total resection of the tumor should be the goal of surgery. Mean follow-up period was 8.3 years and favorable seizure outcome was found to be 91.4%. Surgery decreased AED usage and mean number of AED significantly decreased. Children also benefited from surgery as adults. Surgical treatment of tumor-related epilepsy from temporal lobe controls seizures, and total removal should be the main goal of surgery as neuropsychological testing permit.
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Affiliation(s)
- Rahsan Kemerdere
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Odhan Yuksel
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Tibet Kacira
- Department of Neurosurgery, Sakarya University, Sakarya, Turkey
| | - Naz Yeni
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Cigdem Ozkara
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Taner Tanriverdi
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Mustafa Uzan
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Emin Ozyurt
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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16
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Sommer B, Grummich P, Hamer H, Bluemcke I, Coras R, Buchfelder M, Roessler K. Frameless stereotactic functional neuronavigation combined with intraoperative magnetic resonance imaging as a strategy in highly eloquent located tumors causing epilepsy. Stereotact Funct Neurosurg 2013; 92:59-67. [PMID: 24356382 DOI: 10.1159/000355216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/22/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Intractable epilepsy due to tumors located in highly eloquent brain regions is often considered surgically inaccessible because of a high risk of postoperative neurological deterioration. Intraoperative MRI and functional navigation contribute to overcome this problem. OBJECTIVES To retrospectively investigate the long-term results and impact of functional neuronavigation and 1.5-tesla intraoperative MRI on patients who underwent surgery of tumors associated with epilepsy located close to or within eloquent brain areas. METHODS Nineteen patients (9 female, 10 male, mean age 41.4 ± 13.4 years, 11 low-grade and 8 high-grade glial tumors) were evaluated preoperatively using BOLD imaging, diffusion-tensor imaging tractography and magnetoencephalography. Functional data were implemented into neuronavigation in this multimodal approach. RESULTS In 14 of 19 patients (74%), complete resection was achieved, and in 5 patients significant tumor volume reduction was accomplished. Eight of 14 (57%) complete resections were achieved only by performing an intraoperative image update. Neurological deterioration was found permanently in 2 patients. After a mean follow-up of 43.8 ± 23.8 months, 15 patients (79%) became seizure free (Engel class Ia). CONCLUSIONS Despite the highly eloquent location of tumors causing intractable epilepsy, our multimodal approach led to complete resection in more than two-thirds of patients with an acceptable neurological morbidity and excellent long-term seizure control.
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Affiliation(s)
- Bjoern Sommer
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
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17
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Vannemreddy PSSV, Kanner AM, Smith MC, Rossi M, Wallace D, Vannemreddy SNK, Byrne RW. Chronic epilepsy due to low grade temporal lobe tumors and due to hippocampal sclerosis: do they differ in post-surgical outcome? J Neurooncol 2013; 115:225-31. [PMID: 23955571 DOI: 10.1007/s11060-013-1217-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/04/2013] [Indexed: 12/28/2022]
Abstract
Chronic seizures as a presenting feature of low grade temporal lobe gliomas and hippocampal sclerosis (HS) are reported to have similar outcomes although the prognostic indicators may not be the same. This study seeks to identify the variables that are associated with poor surgical outcome in both conditions. A retrospective analysis from our epilepsy data base was performed. All low-grade temporal lobe gliomas were selected and relevant variables were compared to the same variables in HS patients. There were 34 tumors (out of 233 cases of chronic temporal lobe epilepsy = 14.6 %) with a mean age of onset of 19 years, and the preoperative duration was 12.3 years. When compared to 120 HS patients both of these factors were significantly different (p < 0.001). Age at the time of surgery for tumors was 31.08 (p = 0.5). Tumors were left sided in 20 patients. In tumor cases amygdala resection was complete in 75 %, for hippocampus 24 % were complete and 39 % partial. Astrocytoma, ganglioglioma and oligodendroglioma constituted 80 % of tumor cases. Good outcome (Engel's Class I) was achieved in 88.2 % of tumor cases and 71 % of HS cases while poor outcome (Class III + IV) was seen in 5.9 and 16.7 % respectively. The follow up period for the two groups was not significantly different. In multivariate logistic regression analysis, the groups differed significantly in preoperative delay (between diagnosis and surgery) and in epilepsy outcome. Chronic temporal lobe epilepsy due to low-grade tumors had significantly better surgical outcome with considerably less preoperative delay. The age of onset of seizures was younger in HS patients but a delay in surgical treatment was significantly longer. Given that the diagnosis of treatment-resistant TLE secondary to HS can be established after two failed AED trials at optimal doses, shortening the interval between diagnosis and surgery may improve epilepsy outcome.
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Affiliation(s)
- Prasad S S V Vannemreddy
- Department of Neurosurgery, Rush University Medical Center, 1725 W Harrison Street, Chicago, IL, USA,
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18
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Dozza DC, Rodrigues FF, Chimelli L. Dysembryoplastic neuroepithelial tumor originally diagnosed as astrocytoma and oligodendroglioma. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:710-4. [DOI: 10.1590/s0004-282x2012000900012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 01/24/2012] [Indexed: 11/22/2022]
Abstract
Dysembryoplastic neuroepithelial tumor (DNT), described in 1988 and introduced in the WHO classification in 1993, affects predominantly children or young adults causing intractable complex partial seizures. Since it is benign and treated with surgical resection, its recognition is important. It has similarities with low-grade gliomas and gangliogliomas, which may recur and become malignant. OBJECTIVES: To investigate whether DNT was previously diagnosed as astrocytoma, oligodendroglioma, or ganglioglioma and to determine its frequency in a series of low-grade glial/glio-neuronal tumors. METHODS: Clinical, radiological, and histological aspects of 58 tumors operated from 1978 to 2008, classified as astrocytomas (32, including 8 pilocytic), oligodendrogliomas (12), gangliogliomas (7), and DNT (7), were reviewed. RESULTS: Four new DNT, one operated before 1993, previously classified as astrocytoma (3) and oligodendroglioma (1), were identified. One DNT diagnosed in 2002 was classified once more as angiocentric glioma. Therefore, 10 DNT (17.2%) were identified. CONCLUSIONS: Clinical-radiological and histopathological correlations have contributed to diagnose the DNT.
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Abstract
The term long-term epilepsy associated tumor (LEAT) encompasses lesions identified in patients investigated for long histories (often 2 years or more) of drug-resistant epilepsy. They are generally slowly growing, low grade, cortically based tumors, more often arising in younger age groups and in many cases exhibit neuronal in addition to glial differentiation. Gangliogliomas and dysembryoplastic neuroepithelial tumors predominate in this group. LEATs are further united by cyto-architectural changes that may be present in the adjacent cortex which have some similarities to developmental focal cortical dysplasias (FCD); these are now grouped as FCD type IIIb in the updated International League Against Epilepsy (ILAE) classification. In the majority of cases, surgical treatments are beneficial from both perspectives of managing the seizures and the tumor. However, in a minority, seizures may recur, tumors may show regrowth or recurrence, and rarely undergo anaplastic progression. Predicting and identifying tumors likely to behave less favorably are key objectives of the neuropathologist. With immunohistochemistry and modern molecular pathology, it is becoming increasingly possible to refine diagnostic groups. Despite this, some LEATs remain difficult to classify, particularly tumors with "non-specific" or diffuse growth patterns. Modification of LEAT classification is inevitable with the goal of unifying terminological criteria applied between centers for accurate clinico-pathological-molecular correlative data to emerge. Finally, establishing the epileptogenic components of LEAT, either within the lesion or perilesional cortex, will elucidate the cellular mechanisms of epileptogenesis, which in turn will guide optimal surgical management of these lesions.
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Affiliation(s)
- Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL, Institute of Neurology, Queen Square, London, UK.
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20
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Wallace D, Ruban D, Kanner A, Smith M, Pitelka L, Stein J, Vannemreddy PSSV, Whisler WW, Byrne RW. Temporal lobe gangliogliomas associated with chronic epilepsy: long-term surgical outcomes. Clin Neurol Neurosurg 2012; 115:472-6. [PMID: 22727209 DOI: 10.1016/j.clineuro.2012.05.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 03/14/2012] [Accepted: 05/28/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the clinical features and surgical outcome in patients with temporal lobe gangliogliomas associated with intractable chronic epilepsy. METHODS The Rush University Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of temporal lobe gangliogliomas at Rush University Medical Center. Medical records were reviewed for age of seizure onset, delay to referral for surgery, seizure frequency and characteristics, pre-operative MRI results, extent of resection, pathological diagnosis, complications, length of follow-up, and seizure improvement. RESULTS Fifteen patients were identified. Average duration between seizure onset and surgery was 14.3 years. Complex partial seizures were the most common presenting symptom. Detailed operative data was available for 11 patients - of these, 90.9% underwent complete resection of the amygdala and either partial or complete resection of the hippocampus, in addition to lesionectomy. Average follow-up was 10.4 years (range 1.6-27.5 years), with 14 patients improving to Engel's class I and one patient to Engel's class III. There were no recurrences, and permanent complications were noted in one patient. CONCLUSIONS Long-term follow-up of patients with temporal lobe gangliogliomas associated with chronic intractable epilepsy demonstrates excellent results in seizure improvement with surgery and increasingly low incidence of complications with improvements in microsurgical techniques.
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Affiliation(s)
- David Wallace
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States.
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One hundred and one dysembryoplastic neuroepithelial tumors: an adult epilepsy series with immunohistochemical, molecular genetic, and clinical correlations and a review of the literature. J Neuropathol Exp Neurol 2011; 70:859-78. [PMID: 21937911 DOI: 10.1097/nen.0b013e3182302475] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Simple and complex forms of dysembryoplastic neuroepithelial tumors (DNTs) are readily recognizable but forms with diffuse growth pattern, and hybrid tumors, that is, mixed DNT and ganglioglioma (DNT/GG), are more contentious entities. Rare DNTs have shown aggressive behavior. We reviewed cortical growth patterns, immunophenotype (including CD34, nestin and calbindin), genetic profile, and outcome in 101 DNT in adults. Simple (n = 18), complex (n = 31), diffuse (n = 35) DNT, and mixed DNT/GG (n = 17) showed no difference in age of onset, associated seizure type, or outcome (67.5% free from seizure; mean follow-up, 6 years). CD34 was seen in 61%, calbindin in 57%, and nestin in 86% of all DNT types; these markers were less common in simple DNT. Peritumoral cortical changes (Layer I hypercellularity [61%], satellite nodules [51.6%]) were frequent, but dyslamination (cortical dysplasia) was not identified. Molecular genetic abnormalities identified in 17 cases were IDH1 mutation (n = 3), 1p/19q loss (n = 10), isolated loss 9q (n = 2), and PTEN loss (n = 3), which were not associated with tumor type or location, higher cell proliferation, or distinguishing clinical features (mean age of epilepsy onset, 9 years; age at surgery = 31 years; 69% free from seizure); none had progression on magnetic resonance imaging (mean follow-up, 6 years). No single feature was predictive of seizure-free outcome, but there was a trend for better outcome in CD34-positive tumors (p = 0.07). One case has shown transformation to a higher grade. This study supports the existence of a range of subtypes of DNT some with overlapping features with ganglioglioma; molecular genetic abnormalities were not predictive of atypical behavior.
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Keiner D, Gaab MR, Backhaus V, Piek J, Oertel J. Water jet dissection in neurosurgery: an update after 208 procedures with special reference to surgical technique and complications. Neurosurgery 2011; 67:342-54. [PMID: 21099557 DOI: 10.1227/neu.0b013e3181f743bb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Water jet dissection represents a promising technique for precise brain tissue dissection with preservation of blood vessels. In the past, the water jet dissector has been used for various pathologies. A detailed report of the surgical technique is lacking. OBJECTIVE The authors present their results after 208 procedures with a special focus on surgical technique, intraoperative suitability, advantages, and disadvantages. METHODS Between March 1997 and April 2009, 208 patients with various intracranial neurosurgical pathologies were operated on with the water jet dissector. Handling of the device and its usefulness and extent of application were assessed. The pressures encountered, potential risks, and complications were documented. The patients were followed 1 to 24 months postoperatively. RESULTS A detailed presentation of the surgical technique is given. Differences and limitations of the water jet dissection device in the various pathologies were evaluated. The water jet dissector was intensively used in 127 procedures (61.1%), intermittently used in 56 procedures (26.9%), and scarcely used in 25 procedures (12%). The device was considered to be very helpful in 166 procedures (79.8%) and helpful to some extent in 33 procedures (15.9%). In 8 (3.8%) procedures, it was not helpful, and in 1 procedure (0.5%), the usefulness was not documented by the surgeon. CONCLUSION The water jet dissector can be applied easily and very safely. Precise tissue dissection with preservation of blood vessels and no greater risk of complications are possible. However, the clinical consequences of the described qualities need to be demonstrated in a randomized clinical trial.
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Affiliation(s)
- Doerthe Keiner
- Department of Neurosurgery, Johannes-Gutenberg-University, Mainz, Germany
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Vercueil L. Brain tumor epilepsy: A reappraisal and six remaining issues to be debated. Rev Neurol (Paris) 2011; 167:751-61. [PMID: 21890158 DOI: 10.1016/j.neurol.2011.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 08/08/2011] [Indexed: 12/28/2022]
Affiliation(s)
- L Vercueil
- INSERM U836, EFSN, Psychiatry and Neurology Pole, Grenoble Institut of Neurosciences, CHU Grenoble, Grenoble cedex 9, France.
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Abstract
Much of the literature on tumors arising in the setting of chronic epilepsy focuses on children. This study reviewed 1 institution's 141-patient experience with tumors in adults arising in this clinical setting. The majority of tumors (71.6%) arose in the temporal lobe. The most common tumor types encountered included ganglioglioma (n = 38), low-grade fibrillary astrocytoma (n = 24), and low-grade oligodendroglioma (n = 22). Coexistent focal cortical dysplasia (type IA) was identified in 15 cases (10.6%). The largest group of tumors in adults were World Health Organization (WHO) grade II neoplasms compared with WHO grade I tumors in children. Gangliogliomas are the most commonly encountered neoplasms. Coexistent focal cortical dysplasia may be observed in a significant minority of tumors, suggesting a possible developmental origin for some of these neoplasms.
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Affiliation(s)
- Richard A Prayson
- Departmentof Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA
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Hindi-Ling H, Kipervasser S, Neufeld MY, Andelman F, Nagar S, Chistik V, Veshchev I, Fried I, Kramer U. Epilepsy surgery in children compared to adults. Pediatr Neurosurg 2011; 47:180-5. [PMID: 22041475 DOI: 10.1159/000331568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 08/04/2011] [Indexed: 11/19/2022]
Abstract
AIM The purpose of this study was to compare the frequency of various surgical techniques and surgical outcome between pediatric and adult populations that underwent epilepsy surgery by the same team. METHODS All patients who underwent epilepsy surgery at the Tel Aviv Medical Center between 1997 and 2006 and had been followed up for >2 years were eligible for this study. The majority (90%) of all epilepsy surgeries carried out in Israel were performed in this institution and by a single neurosurgeon. Only patients that underwent video-EEG monitoring as part of the presurgical evaluation were included in the study. RESULTS A total of 186 patients (131 adults and 55 children) underwent epilepsy surgery in our institute during the study period, and follow-up was available for 177 patients (95%). While the adults underwent significantly more temporal lobe resections (51 vs. 20%, p < 0.0001), the children had significantly more extra-temporal non-lesional resections (18 vs. 1%, p < 0.0001) and hemispherectomies (5 vs. 1%, p = 0.002). Over one half (54%) of all the patients had a postoperative reduction in seizures of >90%, and 72% had a reduction of >50%, with no group difference in surgical success. Among the lesionectomies, the outcome was better for tumors, especially those in the temporal lobe. Only 1% of the patients had a long-term neurological deficit. CONCLUSIONS Children comprised 30% of the epilepsy surgical cases during the study period. Children underwent more non-lesional resections and hemispherectomies, while adults underwent more temporal lobe resections. There was no age-related difference in surgical outcome.
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Affiliation(s)
- Hila Hindi-Ling
- Department of Statistics and Operational Research, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
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Abstract
BACKGROUND Along with malformations of cortical development or cortical dysplasia, hippocampal sclerosis, and remote ischaemic damage, tumours are among the more commonly identifiable causes of medically intractable seizures in paediatric age patients. This study reviews one institution's 20 year experience with tumours arising in this clinical setting. METHODS Retrospective review of 129 paediatric patients [less than 19 years of age, 65 females (50.4%)] with tumours and medically intractable seizures encountered during a 20 year period of time (1989-2009). Using the most recent World Health Organization (WHO) classification of brain tumours, tumour type and grade were assessed. RESULTS The most common sites of origin included temporal lobe (n = 77, 59.7%), parietal lobe (n = 20, 15.5%), and frontal lobe (n = 15, 11.6%). WHO grade included 73 (56.6%) grade I tumours, 32 (24.8%) grade II tumours, and 18 (14%) grade I/II tumours. In six cases (4.7%), a WHO grade was not associated with mass. Tumour types included: ganglioglioma (n = 48, 37.2%), dysembryoplastic neuroepithelial tumour (n = 17, 13.2%), low grade astrocytoma (n = 15, 11.6%), low grade mixed glioma (n = 8, 6.2%), low grade oligodendroglioma (n = 5, 3.9%), meningioangiomatosis (n = 4, 3.1%) angiocentric glioma (n = 3, 2.3%), and dysembryoplastic neuroepithelial tumour/ganglioglioma composite tumour (n = 3, 2.3%). Less frequently observed lesions (n = 1 or 2) included pilocytic astrocytoma, protoplasmic astrocytoma, pleomorphic xanthoastrocytoma, and glioneuronal hamartoma. In 18 cases, distinction between low grade glioma and low grade glioneuronal tumour could not be definitively made. Coexisting malformation of cortical development/cortical dysplasia was noted in 29.8% of evaluable cases. In four tumours, coexistent hippocampal sclerosis was identified. Ki-67 labelling indices were less than 5% in all (n = 51) cases assessed. Of 25 tumours evaluated for chromosome 1p status, only one low grade mixed glioma demonstrated evidence of deletion; only one of 22 evaluated tumours (a low grade mixed glioma) showed evidence of chromosome 19q deletion. CONCLUSION Collectively, WHO grade I glioneuronal tumours account for slightly more than half of all neoplasms which cause intractable epilepsy in paediatric patients. A significant minority of tumours (n = 18, 14%) were difficult to definitively classify as glioma versus glioneuronal tumour, due to extent of sampling. Coexistent pathologies including malformation of cortical development/cortical dysplasia may be observed in a significant minority of tumours, suggesting a possible developmental origin for some tumours arising in this setting.
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Affiliation(s)
- Richard A Prayson
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Ozlen F, Gunduz A, Asan Z, Tanriverdi T, Ozkara C, Yeni N, Yalcinkaya C, Ozyurt E, Uzan M. Dysembryoplastic neuroepithelial tumors and gangliogliomas: clinical results of 52 patients. Acta Neurochir (Wien) 2010; 152:1661-71. [PMID: 20526635 DOI: 10.1007/s00701-010-0696-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/18/2010] [Indexed: 12/14/2022]
Abstract
PURPOSE Dysembryoplastic neuroepithelial tumors (DNET) and gangliogliomas (GG) are generally associated with epilepsy in young patients. Presurgical work-up and postsurgical results vary from center to center. Seizures are commonly focal with secondary generalization, and surgical treatment is often effective. METHODS Twenty-eight patients with DNET and 24 patients with GG were eligible for this retrospective study. The authors present clinical, radiological, and pathological characteristics and seizure outcome of 52 patients histopathologically diagnosed with either a DNET or a GG. RESULTS Characteristically the majority of the tumors showed hypointensity on T(1)-weighted images and increased signal intensity on both T(2)-weighted and FLAIR images. At the last follow-up (mean 54.3 months), overall favorable seizure outcome was 94.2% (n = 49). Twenty-six (92.8%) patients with DNET and 21 (87.5%) patients with GG were seizure free. Complete drug withdrawal was achieved in 26 (50%) patients. Shorter duration of epilepsy (p = 0.02), absence of status epilepticus (p = 0.01), absence of edema on MRI (p = 0.03), absence of seizure within the first month of surgery (p = 0.002), and total resection (p = 0.00001) were associated with favorable outcome with respect to seizure. CONCLUSIONS Our results indicate that a prompt diagnosis and total resection with additional adjacent structures or cortices when feasible are associated with a high epilepsy cure rate. Not only children but also adults benefit from surgical treatment. Although radiological features of DNETs or GGs are helpful, no definitive differences were found between the two types of tumors. Thus, clinical, radiological, and histopathological findings have to be considered together.
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Affiliation(s)
- Fatma Ozlen
- Department of Neurosurgery, Istanbul University, Turkey
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