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Journal of Neurosurgical Sciences 2020 Dec 15

DOI: 10.23736/S0390-5616.20.05144-9


language: English

Seizure-outcome after surgery of low-grade epilepsy associated neuro-epithelial tumors

Anant MEHROTRA 1 , Suyash SINGH 2, Soumen KANJILAL 1, Lily PAL 3, Vimal K. PALIWAL 4, Jayesh SARDHARA 1, Sanjay BEHARI 1

1 Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India; Department of Neurosurgery All India Institute of Medical Sciences, Raebarely, Uttar Pradesh, India; 3 Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India; 4 Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India


BACKGROUND: A majority of patients with glioneuronal tumors present with seizures. Although a number of studies have shown that greater extent of resection improves overall patient survival, few studies have focused on post-operative seizure outcome after resection of these tumors. We aim to characterize seizure control rates in patients undergoing glioneuronal tumor resection and evaluate the association between poor seizure outcome and tumor recurrence or progression.
METHODS: The study population included patients who had undergone resection of glioneuronal tumors between 2014 and 2019 at our institution. Seizure outcome was assessed using Engel grading. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed.
RESULTS: 26 patients (n=16, temporal lobe; n=6, frontal lobe; n=4, parietal lobe) with mean seizures duration of 56.9-months, were assessed. Histopathologically, n=15 dysembryoplastic neurepithelial tumour, n=7 ganglioglioma and n=4 Diffuse lepto-meningeal neuroepithelial tumour. There were 2 cases of complex DNET and one case of DLMNT had associated cortical dysplasia. At mean follow-up of 49.7 months, n=20 Engel 1, n=4 Engel 2 and n=2 had Engel 3 outcome. n=20 underwent gross total excision (n=18 Engel 1 and n=2 Engel 2) and n=6 sub-total excision. Among the 4 patients who needed resurgery, two were in Engel 2 and another two were in Engel 3.
CONCLUSIONS: Good seizure-outcome is likely associated with extent of resection. Younger age of patient, less than one-year of seizure duration and absence of generalization of seizure are good prognostic indicators. The best seizure-control can be achieved by early surgical intervention.

KEY WORDS: Seizure; Glioneuronal tumors; Glioma; Total Excision; Engel

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