Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors

Dario J. Englot, Seunggu J. Han, Mitchel S. Berger, Nicholas M. Barbaro, Edward F. Chang

Research output: Contribution to journalArticle

117 Scopus citations

Abstract

BACKGROUND: Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life. OBJECTIVE: To assess how the extent of temporal lobe resection influences seizure outcome. METHODS: We performed a quantitative, comprehensive systematic literature review of seizure control outcomes in 1181 patients with epilepsy across 41 studies after surgical resection of low-grade temporal lobe gliomas and glioneuronal tumors. We measured seizure-freedom rates after subtotal resection vs gross-total lesionectomy alone vs tailored resection, including gross-total lesionectomy with hippocampectomy and/or anterior temporal lobe corticectomy. RESULTS: Included studies were observational case series, and no randomized, controlled trials were identified. Although only 43% of patients were seizure-free after subtotal tumor resection, 79% of individuals were seizure-free after gross-total lesionectomy (OR = 5.00, 95% confidence interval [CI]: 3.33-7.14). Furthermore, tailored resection with hippocampectomy plus corticectomy conferred additional benefit over gross-total lesionectomy alone, with 87% of patients achieving seizure freedom (OR = 1.82, 95% CI: 1.23-2.70). Overall, extended resection with hippocampectomy and/or corticectomy over gross-total lesionectomy alone significantly predicted seizure freedom (OR = 1.18, 95% CI: 1.11-1.26). Age <18 years and mesial temporal location also prognosticated favorable seizure outcome. CONCLUSION: Gross-total lesionectomy of low-grade temporal lobe tumors results in significantly improved seizure control over subtotal resection. Additional tailored resection including the hippocampus and/or adjacent cortex may further improve seizure control, suggesting dual pathology may sometimes allow continued seizures after lesional excision.

Original languageEnglish (US)
Pages (from-to)921-927
Number of pages7
JournalNeurosurgery
Volume70
Issue number4
DOIs
StatePublished - Apr 1 2012

Keywords

  • Corticectomy
  • Epilepsy
  • Glioneuronal tumor
  • Hippocampectomy
  • Low-grade glioma
  • Subtotal
  • Temporal lobe

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Englot, D. J., Han, S. J., Berger, M. S., Barbaro, N. M., & Chang, E. F. (2012). Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors. Neurosurgery, 70(4), 921-927. https://doi.org/10.1227/NEU.0b013e31823c3a30