Impact on Seizure Control of Surgical Resection or Radiosurgery for Cerebral Arteriovenous Malformations

Neurosurgery ◽  
2013 ◽  
Vol 73 (4) ◽  
pp. 648-656 ◽  
Author(s):  
Joanna Y. Wang ◽  
Wuyang Yang ◽  
Xiaobu Ye ◽  
Daniele Rigamonti ◽  
Alexander L. Coon ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Seizure Control ◽  
De Novo ◽  
Seizure Freedom ◽  
Study Population ◽  
Posttreatment Period ◽  
Grade Ii ◽  
The Impact

Abstract BACKGROUND: Seizures are a common presenting symptom of arteriovenous malformations (AVMs). However, the impact of treatment modality on seizure control remains unclear. OBJECTIVE: To compare seizure control after surgical resection or radiosurgery for AVMs. METHODS: We analyzed retrospectively collected information for 378 patients with cerebral AVMs treated at our institution from 1990 to 2010. The application of strict inclusion criteria resulted in a study population of 164 patients. RESULTS: In our cohort, 31 patients (20.7%) had Spetzler-Martin grade I AVMs, 51 (34.0%) grade II, 47 (31.3%) grade III, 20 (13.3%) grade IV, and 1 (0.7%) grade V. Of the 49 patients (30%) presenting with seizures, 60.4% experienced seizure persistence after treatment. For these patients, radiosurgery was associated with seizure recurrence (odds ratio: 4.32, 95% confidence interval: 1.24-15.02, P = .021). AVM obliteration was predictive of seizure freedom at last follow-up (P = .002). In contrast, for patients presenting without seizures, 18.4% experienced de novo seizures after treatment, for which surgical resection was identified as an independent risk factor (hazard ratio: 8.65, 95% confidence interval: 3.05-24.5, P < .001). CONCLUSION: Although our data suggest that achieving seizure freedom should not be the primary goal of AVM treatment, surgical resection may result in improved seizure control compared with radiosurgery for patients who present with seizures. Conversely, in patients without presenting seizures, surgical resection increases the risk of new-onset seizures compared with radiosurgery, but primarily within the early posttreatment period. Surgical resection and radiosurgery result in divergent seizure control rates depending on seizure presentation.

Extent of Resection and Residual Tumor Thresholds for Postoperative Total Seizure Freedom in Epileptic Adult Patients Harboring a Supratentorial Diffuse Low-Grade Glioma

Neurosurgery ◽  
2018 ◽  
Vol 85 (2) ◽  
pp. E332-E340 ◽  
Author(s):  
Megan E H Still ◽  
Alexandre Roux ◽  
Gilles Huberfeld ◽  
Luc Bauchet ◽  
Marie-Hélène Baron ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Surgical Resection ◽  
Seizure Control ◽  
Tumor Volume ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Seizure Freedom ◽  
Low Grade ◽  
Postoperative Seizure

Abstract BACKGROUND Epileptic seizures impair quality of life in diffuse low-grade glioma (DLGG) patients. Tumor resection significantly impacts postoperative seizure control, but the precise extent of resection (EOR) required for optimal seizure control is not clear yet. OBJECTIVE To identify the EOR and residual tumor volume that correlated to postoperative seizure control, defined as a total seizure freedom (Class 1A in reference to Engel classification system) with and without antiepileptic drugs in patients undergoing surgical resection of supratentorial DLGG. METHODS A retrospective review was conducted of all patients who underwent first-line surgical resection of supratentorial DLGG who presented with preoperative seizures without adjuvant oncological treatment. EOR and residual tumor volume were quantified from pre- and post-operative magnetic resonance imagings. Receiver operating characteristic curves were plotted to determine the EOR and residual tumor volume that corresponded to optimal postoperative seizure control. RESULTS Of the 346 included patients, 65.5% had controlled seizures postoperatively, with higher age at resection (adjusted OR per unit, 1.03 [95% confidence interval:1.01-1.06], P = .043) and higher percentage of resection (adjusted OR per unit, 1.02 [95% confidence interval:1.00-1.03], P < .001) found as independent predictors of postoperative seizure control. Optimal EOR was ≥91% and optimal residual tumor volume was ≤19 cc to improve postoperative seizure control. CONCLUSION Postoperative seizure control is more likely when EOR is ≥91% and/or when residual tumor volume is ≤19 cc in supratentorial DLGG gliomas who present with seizures. Resected peritumoral cortex should, however, be taken into account in future studies.

scholarly journals Impact of the Health Transformation Plan on the Number of Surgical Operations and Their Cancelation

2019 ◽  
Vol 56 ◽  
pp. 004695801984638
Author(s):  
MahmoodReza Miri Bonjar ◽  
Mohammad Khammarnia ◽  
Mahdie Bakhshi ◽  
Alireza Ansari-Moghaddam ◽  
Hassan Okati–Aliabad ◽  
...  
Keyword(s):  
Health Insurance ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Outpatient Service ◽  
Public Hospitals ◽  
Inpatient Service ◽  
Treatment Needs ◽  
Study Population ◽  
The Impact ◽  
Surgical Operations

Operation cancelations are a serious problem with undesirable consequences. The Health Transformation Plan was launched in the health system of Iran on May 5, 2014, to enhance the efficiency and quality of services in public hospitals. Comprehensive coverage of patients’ basic treatment needs and reduction of patients’ out-of-pocket expenditures through insurance for all are other objectives of Health Transformation Plan as well. Then, the present study aimed to determine the impact of the Health Transformation Plan on the number of surgical operations and the cancelation of elective surgeries within public hospitals of Iran. This retrospective comparative study was conducted in 2017 within 2 tertiary public hospitals in the South-East of Iran. Using systematic random sampling method and census, 8138 scheduled surgical files and all canceled operations files were reviewed from April 2012 to March 2017, respectively. A standard checklist was used for data collection. The data were analyzed using χ2 test and a logistic regression model in SPSS, version 21. The study population was 8138 patients with mean age of 33 ± 19 years. Female patients comprised about 51% of the study population (n = 4115), and nearly two-third of them were married (n = 5192 [63.79%]). Coverage by Iranian health insurance was reported in more than half of patients (n = 4415 [54.79%]). The common reason for surgeries was injury and poisoning (n = 2814 [34.52%]) followed by delivery (n = 1747 [21.46%]). The number of operations increased from 26 677 before Health Transformation Plan (cancelation rate = 1.5%) to 33 190 after Health Transformation Plan (cancelation rate = 2.0%). The cancelation rate had a significant relationship with age (odds ratio = 1.009; confidence interval: 1.00-1.01), health insurance status (odds ratio = 2.12; confidence interval: 1.33-3.38), outpatient service referrals (odds ratio = 0.5; confidence interval: 0.43-0.62), inpatient service referrals (odds ratio = 1.5; confidence interval: 1.36-1.77), and surgical types ( P < .05). In general, the Health Transformation Plan was markedly associated with a rise in the number of surgeries and cancelation rate in the public hospitals. The information obtained in the present study concerning the causes of operation cancelations can be used to decrease the number of future cancelations.

Seizure outcomes following radiosurgery for cerebral arteriovenous malformations

2014 ◽  
Vol 37 (3) ◽  
pp. E17 ◽  
Author(s):  
Ching-Jen Chen ◽  
Srinivas Chivukula ◽  
Dale Ding ◽  
Robert M. Starke ◽  
Cheng-Chia Lee ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Seizure Control ◽  
Case Series ◽  
Outcome Data ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Cerebral Arteriovenous Malformations ◽  
Control Seizure ◽  
Free Status

Object Seizures are a common presentation of cerebral arteriovenous malformations (AVMs). The authors evaluated the efficacy of stereotactic radiosurgery (SRS) for the management of seizures associated with AVMs and identified factors influencing seizure outcomes following SRS for AVMs. Methods A systematic literature review was performed using PubMed. Studies selected for review were published in English, included at least 5 patients with both cerebral AVMs and presenting seizures treated with SRS, and provided post-SRS outcome data regarding obliteration of AVMs and/or seizures. Demographic, radiosurgical, radiological, and seizure outcome data were extracted and analyzed. All seizure outcomes were categorized as follows: 1) seizure free, 2) seizure improvement, 3) seizure unchanged, and 4) seizure worsened. Systematic statistical analysis was conducted to assess the effect of post-SRS AVM obliteration on seizure outcome. Results Nineteen case series with a total of 3971 AVM patients were included for analysis. Of these, 28% of patients presented with seizures, and data for 997 patients with available seizure outcome data who met the inclusion criteria were evaluated. Of these, 437 (43.8%) patients achieved seizure-free status after SRS, and 530 (68.7%) of 771 patients with available data achieved seizure control (seizure freedom or seizure improvement) following SRS. Factors associated with improved seizure outcomes following SRS for AVMs were analyzed in 9 studies. Seizure-free status was achieved in 82% and 41.0% of patients with complete and incomplete AVM obliteration, respectively. Complete AVM obliteration offered superior seizure-free rates compared with incomplete AVM obliteration (OR 6.13; 95% CI 2.16–17.44; p = 0.0007). Conclusions Stereotactic radiosurgery offers favorable seizure outcomes for AVM patients presenting with seizures. Improved seizure control is significantly more likely with complete AVM obliteration.

BRAFv600e mutated gliomas: From biology to radiology and treatments.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13552-e13552
Author(s):  
Benoit Lhermitte ◽  
Eric Guerin ◽  
Agathe Chammas ◽  
Izzie Jacques Namer ◽  
Guillaume Gauchotte ◽  
...  
Keyword(s):  
Surgical Resection ◽  
De Novo ◽  
Mapk Signaling ◽  
Braf V600e ◽  
Glioneuronal Tumor ◽  
Low Grade ◽  
Diffuse Glioma ◽  
Metabolomic Profile ◽  
Cdkn2a Deletion ◽  
The Impact

e13552 Background: BRAF V600E mutation is encountered in brain tumor, mostly low grade pediatric diffuse glioma (LGG) and epileptogenic glioneuronal tumor such as gangliogliomas (GG) or pleomorphic xanthoastrocytomas (PXA). Less frequently this mutation is present in high grade glial or glioneuronal tumors such as pleomorphic xanthoastrocytomas with anaplasia, anaplastic ganglioglioma, anaplastic diffuse astrocytomas or glioblastomas. Recently, few publications were highlighting differently the impact of BRAF mutation and CDKN2A deletion, as independent prognostic factors linked to a worst outcome in low grade forms. Methods: We studied retrospectively a monocentric cohort of 12 LGGs and 9 HGG with BRAFv600e positivity. The patients were aged from 1 to 47 years. Most of the LGG were under 25 years and only 3 patients with HGGs had less than 18 years old. We focused on extended biology assessment by Next generation sequencing of the tumors and their relapses, tumor metabolomics analyses, radiology comprising MRI, PET-scanning and spectroscopy and correlate them to tumor’s evolution and its treatment. Results: Among the LGGs, we had 9 GG and 3 pilocytic astrocytomas and only one had a CDKN2A deletion and one a gain on chromosome 5. 6 had a complete surgical resection, 2 had a minimal residue and 4 had chemotherapeutic treatment after partial surgery and underwent relapses. All HGGs had a surgical resection followed by chemotherapy (mainly Stupp protocol) and radiotherapy. 5 relapsed rapidly, benefit from targeted therapy with vemurafenib and are still in long term remission. In this HGG group, we had two subgroups: 4 patients with “de novo” tumors and 5 patients with a past history of LGG tumors in the same brain region. Both were responding well to targeted treatments and all had an additional CDKN2A deletion. Specific radiological and spectroscopic signs were linked to those two groups and seem to be associated to a specific metabolomic profile in each group. Currently, we are going further in the correlation between MAPK signaling pathway and metabolomic profile to be able to predict in LGG their potential evolution. Conclusions: BRAF mutated gliomas seem to have specific radiological and metabolomic correlations associated to their biology

Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 948-953 ◽  
Author(s):  
Karam Moon ◽  
Michael R. Levitt ◽  
Rami O. Almefty ◽  
Peter Nakaji ◽  
Felipe C. Albuquerque ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Low Grade ◽  
Stroke Rate ◽  
Modified Rankin Scale ◽  
Postoperative Neurological Deficit ◽  
Clinical Impairment ◽  
Grade Ii

BACKGROUND: Recent studies have questioned the utility of surgical resection of unruptured brain arteriovenous malformations (bAVMs). OBJECTIVE: We performed an assessment of outcomes and complications of surgical resection of low-grade bAVMs (Spetzler-Martin grade I or II) at a single high-volume neurosurgical center. METHODS: We reviewed all unruptured low-grade bAVMs treated with surgery (with or without preoperative embolization) between January 2004 and January 2014. Stroke rate, mortality, and clinical and radiographic outcomes were examined. RESULTS: Of 95 patients treated surgically, 85 (25 grade I, 60 grade II) met inclusion criteria, and all achieved radiographic cure postoperatively. Ten patients (11.8%) were lost to follow-up; the mean follow-up of the remaining 85 was 3.3 years. Three patients (3.5%) with grade II bAVMs experienced a stroke; no patients died. Although 20 patients (23.5%) had temporary postoperative neurological deficit, only 3 (3.5%) had new clinical impairment (modified Rankin Scale score ≥2) at last follow-up. Eight of the 13 patients (61.5%) with preexisting clinical impairment had improved modified Rankin Scale scores of 0 or 1; and 17 of 30 patients (56.7%) with preoperative seizures were seizure-free without antiepileptic medication postoperatively. No significant differences existed in stroke rate or clinical outcome between grades I and II patients at follow-up (Fisher exact test, P = .55 and P &gt; .99, respectively). CONCLUSION: Surgical resection of low-grade unruptured bAVMs is safe, with a high rate of improvement in functional status and seizure reduction. Although transient postoperative neurological deficit was observed in some patients, permanent treatment-related neurological morbidity was rare.

The impact of preradiosurgery embolization on intracranial arteriovenous malformations: a matched cohort analysis based on de novo lesion volume

2020 ◽  
Vol 133 (4) ◽  
pp. 1156-1167 ◽  
Author(s):  
Yi-Chieh Hung ◽  
Nasser Mohammed ◽  
Thomas Jose Eluvathingal Muttikkal ◽  
Kathryn N. Kearns ◽  
Chelsea Eileen Li ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
De Novo ◽  
Cohort Analysis ◽  
Study Cohort ◽  
Lesion Volume ◽  
Collateral Flow ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Maximal Diameter ◽  
The Impact

OBJECTIVEThe benefits and risks of pre–stereotactic radiosurgery (SRS) embolization have been reported in different studies. The goal of this study was to compare the long-term outcome of arteriovenous malformations (AVMs) treated with and without pre-SRS embolization.METHODSA database including 1159 patients with AVMs who underwent SRS was reviewed. The embolized group was selected by including AVMs with pre-SRS embolization, maximal diameter > 30 mm, and estimated volume > 8 ml. The nonembolized group was defined as AVMs treated by SRS alone with matched de novo nidus volume. Outcomes including incidences of favorable clinical outcome (obliteration without hemorrhage, cyst formation, worsening, or new seizures), obliteration, adverse effects, and angioarchitectural complexity were evaluated.RESULTSThe study cohort comprised 17 patients in the embolized group (median AVM volume 17.0 ml) and 35 patients in the nonembolized group (median AVM volume 13.1 ml). The rates of obliteration (embolized cohort: 33%, 44%, and 56%; nonembolized cohort: 32%, 47%, and 47% at 4, 6, and 10 years, respectively) and favorable outcome were comparable between the 2 groups. However, the embolized group had a significantly higher incidence of repeat SRS (41% vs 23%, p = 0.012) and total procedures (median number of procedures 4 vs 1, p < 0.001), even with a significantly higher margin dose delivered at the first SRS (23 Gy vs 17 Gy, p < 0.001). The median angioarchitectural complexity score was reduced from 7 to 5 after embolization. Collateral flow and neovascularization were more frequently observed in the embolized nonobliterated AVMs.CONCLUSIONSBoth embolization plus SRS and SRS alone were effective therapies for moderately large (8–39 ml) AVMs. Even with a significantly higher prescription dose at the time of initial SRS, the embolized group still required more procedures to reach final obliteration. The presence of collateral flow and neovascularization could be risk factors for a failure to obliterate following treatment.

A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia

2012 ◽  
Vol 116 (5) ◽  
pp. 1035-1041 ◽  
Author(s):  
Nathan C. Rowland ◽  
Dario J. Englot ◽  
Tene A. Cage ◽  
Michael E. Sughrue ◽  
Nicholas M. Barbaro ◽  
...  
Keyword(s):  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Meta Analysis ◽  
Large Population ◽  
Cortical Dysplasia ◽  
Seizure Freedom ◽  
Related Factor ◽  
Medline Search ◽  
Postoperative Seizure ◽  
The Impact

Object Focal cortical dysplasia (FCD) is one of the most common causes of medically refractory epilepsy leading to surgery. However, seizure control outcomes reported in isolated surgical series are highly variable. As a result, it is not clear which variables are most crucial in predicting seizure freedom following surgery for FCD. The authors' aim was to determine the prognostic factors for seizure control in FCD by performing a meta-analysis of the published literature. Methods A MEDLINE search of the published literature yielded 37 studies that met inclusion and exclusion criteria. Seven potential prognostic variables were determined from these studies and were dichotomized for analysis. For each variable, individual studies were weighted by inverse variance and combined to generate an odds ratio favoring seizure freedom. The methods complied with a standardized meta-analysis reporting protocol. Results Two thousand fourteen patients were included in the analysis. The overall rate of seizure freedom (Engel Class I) among patients undergoing surgery for FCD in the cohort of studies was 55.8% ± 16.2%. Partial seizures, a temporal location, detection with MRI, and a Type II Palmini histological classification were associated with higher rates of postoperative seizure control. As a treatment-related factor, complete resection of the anatomical or electrographic abnormality was the most important predictor overall of seizure freedom. Neither age nor electroencephalographic localization of the ictal onset significantly affected seizure freedom after surgery. Conclusions Using a large population cohort pooled from the published literature, an analysis identified important factors that are prognostic in patients with epilepsy due to FCD. The most important of these factors—diagnostic imaging and resection—provide modalities through which improvements in the impact of FCD can be effected.

scholarly journals Seizure control after radiosurgery for cerebral arteriovenous malformations: a 25-year experience

2019 ◽  
Vol 131 (6) ◽  
pp. 1763-1772
Author(s):  
Ajay Niranjan ◽  
Ahmed Kashkoush ◽  
Hideyuki Kano ◽  
Edward A. Monaco ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Arteriovenous Malformations ◽  
Seizure Control ◽  
Venous Drainage ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Impaired Awareness ◽  
Free Status

OBJECTIVESeizures are the second-most common presenting symptom in patients with lobar arteriovenous malformations (AVMs). However, few studies have assessed the long-term effect of stereotactic radiosurgery (SRS) on seizure control. The authors of this study assess the outcome of SRS for these patients to identify prognostic factors associated with seizure control.METHODSPatients with AVM who presented with a history of seizure and underwent SRS at the authors’ institution between 1987 and 2012 were retrospectively assessed. The total cohort included 155 patients with a mean follow-up of 86 months (range 6–295 months). Primary outcomes assessed were seizure frequency, antiepileptic drug regimen, and seizure freedom for 6 months prior to last follow-up.RESULTSSeizure-free status was achieved in 108 patients (70%), with an additional 23 patients (15%) reporting improved seizure frequency as compared to their pre-SRS status. The median time to seizure-free status was estimated to be 12 months (95% CI 0–27 months) as evaluated via Kaplan-Meier survival analysis. The mean seizure frequency prior to SRS was 14.2 (95% CI 5.4–23.1) episodes per year. Although not all patients tried, the proportion of patients successfully weaned off all antiepileptic drugs was 18% (28/155 patients). On multivariate logistic regression, focal impaired awareness seizure type (also known as complex partial seizures) and superficial venous drainage were significantly associated with a decreased odds ratio for seizure-free status at last follow-up (OR 0.37 [95% CI 0.15–0.92] for focal impaired awareness seizures; OR 0.36 [95% CI 0.16–0.81] for superficial venous drainage). The effects of superficial venous drainage on seizure outcome were nonsignificant when excluding patients with < 2 years of follow-up. AVM obliteration did not correlate with long-term seizure freedom (p = 0.202, chi-square test).CONCLUSIONSThis study suggests that SRS improves long-term seizure control and increases the likelihood of being medication free, independently of AVM obliteration. Patients with focal impaired awareness seizures were less likely to obtain long-term seizure relief.

Extent of Surgical Resection Predicts Seizure Freedom in Low-Grade Temporal Lobe Brain Tumors

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 921-928 ◽  
Author(s):  
Dario J. Englot ◽  
Seunggu J. Han ◽  
Mitchel S. Berger ◽  
Nicholas M. Barbaro ◽  
Edward F. Chang
Keyword(s):  
Surgical Resection ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Tumor Resection ◽  
Case Series ◽  
Subtotal Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Low Grade ◽  
Glioneuronal Tumors

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 &lt;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.

scholarly journals NCOG-07. FEATURES OF EPILEPTOGENIC BRAIN METASTASES AND THEIR TREATMENT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii130-ii130
Author(s):  
Nicholas Musgrave ◽  
Kristin Huntoon ◽  
Joshua Wang ◽  
Douglas Hardesty ◽  
Daniel Prevedello ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Frontal Lobe ◽  
Surgical Resection ◽  
Seizure Control ◽  
Tumor Resection ◽  
Surgical Patients ◽  
Treatment Modalities ◽  
Categorical Variables ◽  
Systemic Treatments ◽  
The Impact

Abstract Patients with brain metastases (BM) may experience seizures at diagnosis or during their treatment. Seizures are associated with decreased overall survival (OS) and poorer quality of life. Therapeutic options may include surgical resection of epileptogenic BM. This study evaluated features of epileptogenic BM and whether surgical resection of these tumors improved seizure control and OS. A retrospective single-center review between 2006-2016 identified 1581 patients with BM. Data analyzed included demographics, primary cancer, systemic treatments, radiographic features of BM, BM treatment modalities, anti-epileptic drugs (AEDs), and seizure characteristics before and after intervention for BM. Chi-squared tests were used for categorical variables. Kaplan-Meier curves and Breslow values were used to assess OS following seizure. Of 1581 patients with BM, 136 (9%) experienced one or more seizures. Seizure was the presenting symptom of BM in 74 (54.4%) patients. Melanoma metastases were most epileptogenic, causing seizure in 38 of 216 (17.6%) patients (p&lt; 0.001). Frontal lobe metastases were most common in patients with seizures (100, 73.5% p=0.033). After median follow-up of 23 months, 48 of 80 (60%) surgical patients were seizure free compared with 27 of 56 (48.2%) non-surgical patients. OS from first seizure was improved in surgical patients versus non-surgical patients (735±133 vs 447±74 days, p=0.043). Frontal lobe tumor resection (n=61) conferred improved survival compared with non-frontal lobe tumor resections (n=19) (698±323 vs 344±132 days, p=0.044). Variables such as demographics, number of BM, tumor histology, and dose of AED were not significantly different between surgical and non-surgical groups. Seizures due to BM cause significant morbidity and mortality. Frontal lobe location and melanoma histology increase seizure risk. Resection of BM was associated with improved seizure control and prolonged OS from the time of first seizure. Further studies should delineate the impact of surgery and determine if a specific constellation of variables warrants prophylactic AEDs.

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