Seizure outcome of epilepsy surgery in focal epilepsies associated with temporomesial glioneuronal tumors: lesionectomy compared with tailored resection

Abstract

Object The authors retrospectively analyzed and compared seizure outcome in a series of 28 patients with temporomesial glioneuronal tumors associated with epilepsy who underwent 1 of 2 different epilepsy surgery procedures: lesionectomy or tailored resection. Methods The 28 patients were divided into 2 groups, with 14 cases in each group. In Group A, surgery was limited to the tumor (lesionectomy), whereas Group B patients underwent tailored resection involving removal of the tumor and the epileptogenic zone as identified by a neurophysiological noninvasive presurgical study. Results In Group A (10 male and 4 female patients) the interval between onset of seizures and surgery ranged from 1 to 33 years (mean 10.6 years). Patients' ages ranged from 3 to 61 years (mean 23.1 years). The epileptogenic lesion was on the left side in 6 patients and the right in 8 patients. Mean follow-up was 9.8 years (range 6.5–15 years). The Engel classification system, used to determine postoperative seizure outcome, showed 6 patients (42.8%) were Engel Class I and 8 (57.1%) were Engel Class II. In Group B (6 male and 8 female patients) the interval between onset of seizures and surgery ranged from 0.5 to 25 years (mean 8.6 years). Patients' ages ranged from 3 to 48 years (mean 22.3 years). The tumor and associated epileptogenic area was on the right side in 8 patients and the left in 6 patients. Mean follow-up duration was 3.5 years (range 1–6.5 years). Postoperative seizure outcome was Engel Class I in 13 patients (93%) and Engel Class II in 1 (7.1%). Conclusions The authors' results demonstrate a better seizure outcome for temporomesial glioneuronal tumors associated with epilepsy in patients who underwent tailored resection rather than simple lesionectomy (p = 0.005). For temporomesial glioneuronal tumors associated with epilepsy, performing a presurgical noninvasive neurophysiological study intended to identify the epileptogenic zone is necessary for planning a tailored surgery. Using this surgical strategy, the presence of temporomesial glioneuronal tumors constitutes a predictive factor of excellent seizure outcome, and therefore surgical treatment can be offered early to avoid both the consequences of uncontrolled seizures as well as the side effects of pharmacological therapy.