scholarly journals AS2-1 TREATMENT OF BENIGN INTRA-AXIAL BRAIN TUMORS IN CHILDREN ASSOCIATED WITH EPILEPSY

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii1-ii2
Author(s):  
Takeshi Matsuo
Keyword(s):  
Early Onset ◽  
Focal Epilepsy ◽  
Tumor Resection ◽  
Benign Tumors ◽  
Seizure Outcome ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Term Survival ◽  
Daily Lives ◽  
Epithelial Tumors

Abstract Low grade neuro-epithelial tumors presenting early-onset epilepsy as the major neurological symptom have recently been categorized as low-grade epilepsy-associated neuro-epithelial tumors, LEAT. Ganglioglioma and dysembryoplastic neuroepithelial tumors consist up to 60% of LEAT. Common characteristics of LEAT being early onset seizure, younger than the age of 15, and temporal lobe localization, its criteria do not include histological or genetic features; LEAT is an independent classification, unrelated to WHO classification. Treatment for epilepsy associated with LEAT includes medication and surgery. As for drug therapy, most tumor-related seizures are controlled well with anti-epileptic drugs for focal epilepsy such as sodium channel blocker. On the other hand, those who are drug-resistant are candidates for surgical therapy. Because epileptogenic zone mostly exists not in tumor itself but in the marginal brain tissue, pure tumor resection without resection of peripheral epileptogenic zone sometimes fails to achieve satisfactory seizure outcome. Concept of epilepsy surgery is indispensable in pre-operative evaluation and in planning surgical strategy. Related association fibers in addition to five zones, epileptogenic zone, seizure onset zone, irritative zone, symptomatogenic zone and functional deficit zone should be taken into consideration. Long-term survival is expected in children who underwent total resection of benign tumors. Therefore, good seizure control is crucial in improving activities of daily lives.

scholarly journals Surgical and seizure outcome in children with DNETs who underwent epilepsy surgery

2015 ◽  
Vol 42 (S1) ◽  
pp. S22-S22
Author(s):  
AM Bueckert ◽  
J Pugh ◽  
T Snyder ◽  
M Wheatley ◽  
F Jacob ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Epilepsy Surgery ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Benign Tumors ◽  
Seizure Outcome ◽  
Low Grade ◽  
Partial Seizures ◽  
Complex Partial Seizures

Background: Dysembryoblastic neuroepithelial tumors (DNETs) are benign tumors of the cerebral cortex that most commonly occur in children or young adults. Seizures are a frequent presenting feature, with an incidence of 80-100%, and are often an indication for surgical resection. Methods: We performed a retrospective chart review of children with DNETs who underwent epilepsy surgery between 1998 and 2014. Results: A total of 12 subjects were identified (6 males, 6 females), all of whom had seizures prior to surgical resection. Of these patients, 1 had infantile spasms, 2 had simple partial seizures and 10 had complex partial seizures. Tumors were located in the temporal (n=7), frontal (n=3) or parietal (n=2) cortex. These patients went on to have surgery on average 15 months after seizure onset, 3 had incomplete resections. At an average follow up of 6 years 4 months, all patients were class 1 on Engel’s Classification. All but one subject with rare non-disabling seizures were seizure free, with only 6 on medication. Follow up MR imaging revealed tumor recurrence in 1 subject. Conclusions: Despite differing seizure seminology and tumor location, surgical resection of these low-grade tumors resulted in excellent seizure outcome even in the setting of incomplete tumor resection.

scholarly journals The Impact of Lesional Factors on Seizure Outcome Following Lesionectomy as a Surgical Management of Extratemporal Epilepsy, Case Series from a Developing Country and Review of Literature.

2021 ◽  
Author(s):  
Amr Ali Hasanain ◽  
Mohamed Sawan ◽  
Ahmed Mohamed Ali
Keyword(s):  
Focal Epilepsy ◽  
Focal Lesion ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Seizure Semiology ◽  
Radiological Data ◽  
The Impact

Abstract BACKGROUNDExtratemporal lesional epilepsy can be managed with various surgical techniques such as simple lesionectomy or more extensive resections, all of which aim at targeting the epileptogenic zone which is the key for achieving a favorable outcome. This study aimed at evaluating the effectiveness of lesionectomy in the treatment of extra-temporal epilepsy associated with a lesion on radiological imaging, and to show the effect of lesional factors on seizure outcome including the anatomical location, the relation to cerebral parenchyma, the extent of surgical excision and the histopathological nature of the lesion.METHODSA prospective study on 20 patients presenting with focal epilepsy, or focal epilepsy with secondary generalized seizures with evidence of focal lesion in an extratemporal location on MRI. Lesionectomy was done and we used the Engel’s classification for seizure outcome.RESULTSLesions were mostly tumors (85 %). The frontal lobe is the most frequent locations (60 %). Low-grade glioma represented 35 % while meningioma represented 45 % of all lesions (both intra-axial and extra-axial). Four patients were lost during follow up (mean 23.31 months). For the remaining 16 patients, 13 cases were tumors (81.25%). Lesionectomy achieved seizure freedom in 68.75 %.CONCLUSIONSIn a country with limited resources, lesionectomy is a valid technique for epilepsy surgery as long as the radiological data and the seizure semiology are concordant. Total lesionectomy provides good seizure control when the clinical and radiological data are concordant with seizure semiology, in particular with tumor-related epilepsy. A study comparing postoperative seizure outcome between intra-axial and extra-axial lesions on a larger scale and with a longer follow up period is recommended.

scholarly journals Surgical Treatment of Epilepsy in Pediatric Patients

2000 ◽  
Vol 27 (2) ◽  
pp. 106-110 ◽  
Author(s):  
Elaine Wyllie
Keyword(s):  
Pediatric Patients ◽  
Focal Epilepsy ◽  
Hippocampal Sclerosis ◽  
Intractable Epilepsy ◽  
Postoperative Outcome ◽  
Seizure Outcome ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Developmental Issues ◽  
Relative Risks

ABSTRACT:Surgery has become an accepted treatment modality for carefully selected adults with intractable focal epilepsy. More recently, increasing numbers of pediatric patients with intractable epilepsy are also being referred for surgical consideration. Key elements of surgical candidacy include medically intractable focal epilepsy, a localized epileptogenic zone, and a low risk for new postoperative neurologic deficits. The most common etiologies of the epilepsies in pediatric surgical candidates are malformation of cortical development and low grade tumor but some patients with childhood onset temporal lobe epilepsy due to hippocampal sclerosis also present for early surgery. Based on results from several recent pediatric surgical series, the chance for favorable seizure outcome after surgery is not adversely affected by young age, with seizure-free postoperative outcome reported for 60% to 65% of infants, 59% to 67% of children, and 69% of adolescents, compared to 64% reported in a large, predominantly adult series. Some subgroups of patients have higher percentages of seizure-free outcome, including those with hippocampal sclerosis or low grade tumor. In addition to seizures, developmental issues are also a major concern in children with intractable epilepsy. Few quantitative data are available, but some anecdotal experience suggests that surgical relief of catastrophic epilepsy may result in resumption of developmental progression after surgery, although the rate of development often remains abnormal. In one series, best developmental outcomes were seen in patients with earliest surgery and highest level of preoperative development. For each patient, the timing of surgery must be carefully considered, based on a full assessment of the relative risks and benefits, derived from a detailed presurgical evaluation.

Seizure outcome of surgical treatment of focal epilepsy associated with low-grade tumors in children

2013 ◽  
Vol 11 (2) ◽  
pp. 214-223 ◽  
Author(s):  
Micol Babini ◽  
Marco Giulioni ◽  
Ercole Galassi ◽  
Gianluca Marucci ◽  
Matteo Martinoni ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Focal Epilepsy ◽  
Class I ◽  
Seizure Outcome ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Group A ◽  
Children And Young Adults ◽  
Group B ◽  
Age Range

Object Low-grade tumor (LGT) is an increasingly recognized cause of focal epilepsies, particularly in children and young adults, and is frequently associated with cortical dysplasia. The optimal surgical treatment of epileptogenic LGTs in pediatric patients has not been fully established. Methods In the present study, the authors retrospectively reviewed 30 patients (age range 3–18 years) who underwent surgery for histopathologically confirmed LGTs, in which seizures were the only clinical manifestation. The patients were divided into 2 groups according to the type of surgical treatment: patients in Group A (20 cases) underwent only tumor removal (lesionectomy), whereas patients in Group B (11 cases) underwent removal of the tumor and the adjacent epileptogenic zone (tailored surgery). One of the patients, who underwent 2 operations, is included in both groups. Follow-up ranged from 1 to 17 years. Results Sixteen (80%) of 20 patients in Group A had an Engel Class I outcome. In this group, 3 of 4 patients who were in Engel Classes II and III had temporomesial lesions. All patients in Group B had temporomesial tumors and were seizure free (Engel Class I). In this series, in temporolateral and extratemporal tumor locations, lesionectomy yielded a good seizure outcome. In addition, a young age at seizure onset (in particular < 4 years) was associated with a poor seizure outcome. Conclusions Tailored resection in temporomesial LGTs was associated with excellent seizure outcome, indicating that an adequate presurgical evaluation including extensive neurophysiological evaluation (long-term videoelectroencephalography monitoring) to plan appropriate surgical strategy is advised.

Stereoelectroencephalography in Children and Adolescents With Difficult-to-Localize Refractory Focal Epilepsy

Neurosurgery ◽  
2014 ◽  
Vol 75 (3) ◽  
pp. 258-268 ◽  
Author(s):  
Jorge Gonzalez-Martinez ◽  
Jeffrey Mullin ◽  
Juan Bulacio ◽  
Ajay Gupta ◽  
Rei Enatsu ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Pediatric Patients ◽  
Focal Epilepsy ◽  
Early Experience ◽  
Morbidity Rate ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Eloquent Cortex

Abstract BACKGROUND: Although stereoelectroencephalography (SEEG) has been shown to be a valuable tool for preoperative decision making in focal epilepsy, there are few reports addressing the utility and safety of SEEG methodology applied to children and adolescents. OBJECTIVE: To present the results of our early experience using SEEG in pediatric patients with difficult-to-localize epilepsy who were not considered candidates for subdural grid evaluation. METHODS: Thirty children and adolescents with the diagnosis of medically refractory focal epilepsy (not considered ideal candidates for subdural grids and strip placement) underwent SEEG implantation. Demographics, electrophysiological localization of the hypothetical epileptogenic zone, complications, and seizure outcome after resections were analyzed. RESULTS: Eighteen patients (60%) underwent resections after SEEG implantations. In patients who did not undergo resections (12 patients), reasons included failure to localize the epileptogenic zone (4 patients); multifocal epileptogenic zone (4 patients); epileptogenic zone located in eloquent cortex, preventing resection (3 patients); and improvement in seizures after the implantation (1 patient). In patients who subsequently underwent resections, 10 patients (55.5%) were seizure free (Engel class I) and 5 patients (27.7%) experienced seizure improvement (Engel class II or III) at the end of the follow-up period (mean, 25.9 months; range, 12 to 47 months). The complication rate in SEEG implantations was 3%. CONCLUSION: The SEEG methodology is safe and should be considered in children/adolescents with difficult-to-localize epilepsy. When applied to highly complex and difficult-to-localize pediatric patients, SEEG may provide an additional opportunity for seizure freedom in association with a low morbidity rate.

scholarly journals Early Onset Epilepsy Caused by Low-Grade Epilepsy-Associated Tumors and Focal Meningeal Involvement

2020 ◽  
Vol 10 (10) ◽  
pp. 752
Author(s):  
Luca De Palma ◽  
Chiara Pepi ◽  
Alessandro De Benedictis ◽  
Nicola Pietrafusa ◽  
Angela Mastronuzzi ◽  
...  
Keyword(s):  
Surgical Outcome ◽  
Early Onset ◽  
Pediatric Patients ◽  
Seizure Outcome ◽  
Low Grade ◽  
Post Surgery ◽  
Meningeal Involvement ◽  
Patients With Epilepsy ◽  
Associated Tumors

Background: Low-grade epilepsy-associated neuroepithelial tumors (LEATs) are a frequent etiology in pediatric patients with epilepsy undergoing surgery. Objective: To identify differences in clinical and post-surgical follow-up between patients with focal meningeal involvement (MI) and those without MI within our cohort of pediatric patients with LEATs. Methods: We retrospectively reviewed all pediatric patients (<18 y) who underwent epilepsy surgery between 2011 and 2017 at our hospital. Cohort inclusion required histological diagnosis of LEATs and post-surgical follow-up of ≥2 y. We subsequently stratified patients according to presence of neuroradiological MI. Results: We identified 37 patients: five with MI and 32 without. Half of patients (19) were drug sensitive at surgery; similar between groups. The group with MI differed mainly for age of epilepsy-onset (0.6 vs. 7.0 y) but not for epilepsy duration (0.9 vs. 1.5 y). Post-surgery radiological follow-up (median 4.0 y; IQR 2.8–5.0 y) did not indicate disease progression. Seizure outcome was excellent in both groups, with 34 patients overall being both drug- and seizure-free. Conclusions: Our study identified a new subgroup of LEATs with focal MI and excellent post-surgical outcome. Moreover, this highlights the effectiveness of early surgery in pediatric LEATs.

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

2014 ◽  
Vol 120 (1) ◽  
pp. 12-23 ◽  
Author(s):  
Tamara Ius ◽  
Giada Pauletto ◽  
Miriam Isola ◽  
Giorgia Gregoraci ◽  
Riccardo Budai ◽  
...  
Keyword(s):  
Seizure Control ◽  
Tumor Resection ◽  
Low Grade Glioma ◽  
Seizure Outcome ◽  
Low Grade ◽  
Class Iii ◽  
The Difference ◽  
Drug Resistant Epilepsy ◽  
Postoperative Seizure ◽  
The Impact

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.

Technique, Results, and Complications Related to Robot-Assisted Stereoelectroencephalography

Neurosurgery ◽  
2015 ◽  
Vol 78 (2) ◽  
pp. 169-180 ◽  
Author(s):  
Jorge González-Martínez ◽  
Juan Bulacio ◽  
Susan Thompson ◽  
John Gale ◽  
Saksith Smithason ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Interquartile Range ◽  
Implantation Technique ◽  
Target Point ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Robot Assisted ◽  
Depth Electrodes

ABSTRACT BACKGROUND: Robot-assisted stereoelectroencephalography (SEEG) may represent a simplified, precise, and safe alternative to the more traditional SEEG techniques. OBJECTIVE: To report our clinical experience with robotic SEEG implantation and to define its utility in the management of patients with medically refractory epilepsy. METHODS: The prospective observational analyses included all patients with medically refractory focal epilepsy who underwent robot-assisted stereotactic placement of depth electrodes for extraoperative brain monitoring between November 2009 and May 2013. Technical nuances of the robotic implantation technique are presented, as well as an analysis of demographics, time of planning and procedure, seizure outcome, in vivo accuracy, and procedure-related complications. RESULTS: One hundred patients underwent 101 robot-assisted SEEG procedures. Their mean age was 33.2 years. In total, 1245 depth electrodes were implanted. On average, 12.5 electrodes were implanted per patient. The time of implantation planning was 30 minutes on average (range, 15-60 minutes). The average operative time was 130 minutes (range, 45-160 minutes). In vivo accuracy (calculated in 500 trajectories) demonstrated a median entry point error of 1.2 mm (interquartile range, 0.78-1.83 mm) and a median target point error of 1.7 mm (interquartile range, 1.20-2.30 mm). Of the group of patients who underwent resective surgery (68 patients), 45 (66.2%) gained seizure freedom status. Mean follow-up was 18 months. The total complication rate was 4%. CONCLUSION: The robotic SEEG technique and method were demonstrated to be safe, accurate, and efficient in anatomically defining the epileptogenic zone and subsequently promoting sustained seizure freedom status in patients with difficult-to-localize seizures.

scholarly journals Osteopontin as a Prognostic Indicator in Grading of Ovarian Epithelial Tumors

2015 ◽  
Vol 7 (2) ◽  
pp. 61-63
Author(s):  
Ganga S Pilli ◽  
Prakash V Patil ◽  
SG Karadesai
Keyword(s):  
Prognostic Indicator ◽  
Ovarian Tumors ◽  
Benign Tumors ◽  
P Value ◽  
Low Grade ◽  
High Grade ◽  
Osteopontin Expression ◽  
Epithelial Tumors ◽  
Ovarian Epithelial Tumors ◽  
Ovarian Cancers

ABSTRACT Aim To determine if osteopontin expression by immunohistochemistry (IHC) can correlate with histological type and grade of epithelial ovarian cancer. Materials and methods The present work has been carried out at department of pathology, of a reputed medical college in Belgaum district of Karnataka state. The study is carried out for a period of 18 months for data collection, evaluation of the marker and data analysis. All consecutive specimens of ovarian tumors are included in the study. The study included 55 epithelial ovarian tumors and these are analyzed histopathologically. In all the cases, osteopontin expression has been studied with IHC on paraffin slides. Results This study included 41 (74.5%) benign tumors and 14 (25.5%) malignant tumors. High grade (grade III) was common in serous carcinomas than in other histological types. Fisher's exact test p-value < 0.001 was significant for expression of osteopontin and all the malignant ovarian epithelial tumors expressed osteopontin by IHC procedure on paraffin tissue sections. All high-grade epithelial ovarian tumors showed increased expression of osteopontin of +++ and low-grade tumors expressed +/++osteopontin. Conclusion The osteopontin expression was seen in all the malignant epithelial ovarian cancers and the osteopontin expression was significantly higher in high-grade epithelial ovarian cancers than low-grade epithelial ovarian cancers. How to cite this article Pilli GS, Patil PV, Karadesai SG. Osteopontin as a Prognostic Indicator in Grading of Ovarian Epithelial Tumors. J South Asian Feder Obst Gynae 2015;7(2): 61-63.

Ganglioglioma: A Correlative Clinicopathological and Radiological Study of Ten Surgically Treated Cases with Follow-Up

Neurosurgery ◽  
1987 ◽  
Vol 20 (3) ◽  
pp. 428-433 ◽  
Author(s):  
Uma P. Kalyan-Raman ◽  
William C. Olivero
Keyword(s):  
Postoperative Radiotherapy ◽  
Benign Tumors ◽  
Subtotal Resection ◽  
Low Grade ◽  
Term Survival ◽  
Computed Tomographic ◽  
Histological Criteria ◽  
The Central Nervous System

Abstract Gangliogliomas are rare benign tumors of the central nervous system containing neoplastic ganglion and low grade glial cells. In studying 10 surgically treated cases, we evaluated the clinical, pathological, radiological, and immunocytochemical features, with follow-up. Ranging from 18 to 58 years in age, 7 patients were women, and 3 were men. The most common presenting symptom was seizure. Computed tomographic scan showed a low density enhancing mass in 8 and calcification in 5. Six had minimally abnormal vascularity on angiography. Seven patients had total and 3 had subtotal resections of the tumor. The temporal lobe was the location of the tumor in 6 cases. All of the cases met the histological criteria of Russell and Rubinstein for ganglioglioma. Four patients received postoperative radiotherapy because of subtotal resection or aggressive histological makeup. On follow-up, from 2.5 to 7 years, 8 patients are alive and tumorfree, and 7 are also seizure-free. Two died after operation: one immediately and the other of a glioblastoma that developed 5 years later. Our study confirms that ganglioglioma is a distinct histological entity, anatomically localized, with characteristic clinical and radiological findings and long term survival. Aggressive histological makeup is not a definite indication of malignant potential. The definitive role of follow-up radiotherapy for this tumor needs further study. Malignant evolution is rare, but warrants follow-up.

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