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

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.

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Seizure outcome in temporal glioblastoma surgery: lobectomy as a supratotal resection regime outclasses conventional gross-total resection

Journal of Neuro-Oncology ◽

10.1007/s11060-021-03705-x ◽

2021 ◽

Author(s):

Valeri Borger ◽

Motaz Hamed ◽

Inja Ilic ◽

Anna-Laura Potthoff ◽

Attila Racz ◽

...

Keyword(s):

Tumor Resection ◽

Temporal Lobectomy ◽

Secondary Outcome ◽

Seizure Outcome ◽

Seizure Freedom ◽

Secondary Outcome Measure ◽

Total Resection ◽

Class 1 ◽

Postoperative Seizure ◽

The Impact

Abstract Introduction The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures. Methods Between 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors’ institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2–6). Results Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4–515.9). Conclusions ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.

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Surgical treatment of drug-resistant epilepsy caused by gliomas in eloquent areas: experience report

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190160 ◽

2019 ◽

Vol 77 (11) ◽

pp. 797-805

Author(s):

Gustavo Rassier Isolan ◽

Vilson Marth ◽

Leonardo Frizon ◽

Leandro Dini ◽

Símone Dini ◽

...

Keyword(s):

Seizure Control ◽

Univariate Analysis ◽

Extent Of Resection ◽

Seizure Outcome ◽

Low Grade ◽

Microsurgical Anatomy ◽

Drug Resistant ◽

Eloquent Areas ◽

Eloquent Area ◽

Drug Resistant Epilepsy

ABSTRACT Drug-resistant epilepsy associated with central nervous system tumors is generally caused by low grade gliomas. This group of tumors is usually found in brain eloquent areas, such as the insular lobe, rolandic cortex and supplementary motor area and, historically, possess a greater risk of postoperative deficits. Objective: The aim of this investigation was to present our surgical experience on patients with drug-resistant epilepsy caused by gliomas in eloquent areas. We retrospectively investigated variables that impact seizure control, such as tumor location, extent of resection, invasion into the lenticulostriate arteries in the patient, especially those with insular gliomas. Methods: Out of 67 patients with eloquent area brain tumors operated on in our service between 2007 and 2016, 14 patients had symptoms of drug-resistant epilepsy. Volumetric analysis, extent of resection (EOR), type of approach and mapping, among other factors were correlated with the 12-month postoperative seizure outcome. Results: Univariate analysis showed that the factors showing statistical relevance with seizure control were preoperative volume (p = 0.005), EOR (p = 0.028) and postoperative volume (p = 0.030). Conclusion: There was a statistically significant association between the EOR and the Engel score for epilepsy control: an EOR < 70 was associated with Engel II, III, IV and an EOR > 90 was associated with Engel I. Eloquent area gliomas can safely be resected when surgeons use not only microsurgical anatomy concepts but also brain mapping.

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

Neurosurgery ◽

10.1227/neu.0b013e31823c3a30 ◽

2011 ◽

Vol 70 (4) ◽

pp. 921-928 ◽

Cited By ~ 128

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 <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.

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

Neurosurgery ◽

10.1093/neuros/nyy481 ◽

2018 ◽

Vol 85 (2) ◽

pp. E332-E340 ◽

Cited By ~ 9

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.

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Impact of facility type and volume in low-grade glioma outcomes

Journal of Neurosurgery ◽

10.3171/2019.6.jns19409 ◽

2019 ◽

pp. 1-11 ◽

Cited By ~ 4

Author(s):

Ping Zhu ◽

Xianglin L. Du ◽

Angel I. Blanco ◽

Leomar Y. Ballester ◽

Nitin Tandon ◽

...

Keyword(s):

Proportional Hazards ◽

Tumor Resection ◽

High Volume ◽

Cox Proportional Hazards ◽

Low Grade Glioma ◽

Low Grade ◽

Prolonged Length ◽

Cox Proportional Hazards Models ◽

Facility Type ◽

The Impact

OBJECTIVEThe object of this study was to investigate the impact of facility type (academic center [AC] vs non-AC) and facility volume (high-volume facility [HVF] vs low-volume facility [LVF]) on low-grade glioma (LGG) outcomes.METHODSThis retrospective cohort study included 5539 LGG patients (2004–2014) from the National Cancer Database. Patients were categorized by facility type and volume (non-AC vs AC, HVF vs LVF). An HVF was defined as the top 1% of facilities according to the number of annual cases. Outcomes included overall survival, treatment receipt, and postoperative outcomes. Kaplan-Meier and Cox proportional-hazards models were applied. The Heller explained relative risk was computed to assess the relative importance of each survival predictor.RESULTSSignificant survival advantages were observed at HVFs (HR 0.67, 95% CI 0.55–0.82, p < 0.001) and ACs (HR 0.84, 95% CI 0.73–0.97, p = 0.015), both prior to and after adjusting for all covariates. Tumor resection was 41% and 26% more likely to be performed at HVFs vs LVFs and ACs vs non-ACs, respectively. Chemotherapy was 40% and 88% more frequently to be utilized at HVFs vs LVFs and ACs vs non-ACs, respectively. Prolonged length of stay (LOS) was decreased by 42% and 24% at HVFs and ACs, respectively. After tumor histology, tumor pattern, and codeletion of 1p19q, facility type and surgical procedure were the most important contributors to survival variance. The main findings remained consistent using propensity score matching and multiple imputation.CONCLUSIONSThis study provides evidence of survival benefits among LGG patients treated at HVFs and ACs. An increased likelihood of undergoing resections, receiving adjuvant therapies, having shorter LOSs, and the multidisciplinary environment typically found at ACs and HVFs are important contributors to the authors’ finding.

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Seizure Outcome After Surgical Resection of Insular Glioma

Neurosurgery ◽

10.1093/neuros/nyx486 ◽

2017 ◽

Vol 83 (4) ◽

pp. 709-718 ◽

Cited By ~ 8

Author(s):

Doris D Wang ◽

Hansen Deng ◽

Shawn L Hervey-Jumper ◽

Annette A Molinaro ◽

Edward F Chang ◽

...

Keyword(s):

Tumor Progression ◽

Seizure Control ◽

Tumor Resection ◽

Extent Of Resection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Seizure Recurrence ◽

Cox Regression Analysis ◽

Repeat Operation ◽

Postoperative Seizure

Abstract BACKGROUND A majority of patients with insular tumors present with seizures. Although a number of studies have shown that greater extent of resection improves overall patient survival, few studies have documented postoperative seizure control after insular tumor resection. OBJECTIVE To (1) characterize seizure control rates in patients undergoing insular tumor resection, (2) identify predictors of seizure control, and (3) evaluate the association between seizure recurrence and tumor progression. METHODS The study population included adults who had undergone resection of insular gliomas between 1997 and 2015 at our institution. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed. RESULTS One-hundred nine patients with sufficient clinical data were included in the study. At 1 yr after surgery, 74 patients (68%) were seizure free. At final follow-up, 42 patients (39%) were seizure free. Median time to seizure recurrence was 46 mo (95% confidence interval 31-65 mo). Multivariate Cox regression analysis revealed that greater extent of resection (hazard ratio = 0.2899 [0.1129, 0.7973], P = .0127) was a significant predictor of seizure freedom. Of patients who had seizure recurrence and tumor progression, seizure usually recurred within 3 mo prior to tumor progression. Repeat resection offered additional seizure control, as 8 of the 22 patients with recurrent seizures became seizure free after reoperation. CONCLUSION Maximizing the extent of resection in insular gliomas portends greater seizure freedom after surgery. Seizure recurrence is associated with tumor progression, and repeat operation can provide additional seizure control.

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Impact of surgical treatment on tremor due to posterior fossa tumors

Journal of Neurosurgery ◽

10.3171/jns/2008/108/4/0692 ◽

2008 ◽

Vol 108 (4) ◽

pp. 692-697 ◽

Cited By ~ 4

Author(s):

Thomas M. Kinfe ◽

Hans-Holger Capelle ◽

Joachim K. Krauss

Keyword(s):

Surgical Treatment ◽

Posterior Fossa ◽

Dentate Nucleus ◽

Tumor Resection ◽

Low Grade Glioma ◽

The Other ◽

Low Grade ◽

Posterior Fossa Tumors ◽

History Of ◽

The Impact

Object The object of this study was to investigate the impact of surgical treatment on tremor caused by posterior fossa tumors. Methods The authors performed a retrospective evaluation of 6 cases involving patients with tremors due to posterior fossa tumors. Patients who had been treated with neuroleptic medication or had a family history of movement disorders were excluded. All patients had postural or kinetic tremors. Tremor was mainly unilateral. The study group included 5 women and 1 man. Mean age at surgery was 59 years. Five patients underwent total or subtotal tumor resection, and 1 patient underwent stereotactic biopsy only. The histological diagnosis was epidermoid tumor in 2 patients, metastasis in 2 others, and vestibular schwannoma and low-grade glioma in 1 each. Results Two patients had no improvement of tremor, postoperatively. In both of these patients the tumor (low-grade glioma in 1, metastasis in the other) involved the dentate nucleus directly. In the other patients, a compressive effect on the dentate nucleus or the dentatothalamic pathways was present without invasion of the cerebellar structures, and immediate or gradual amelioration of the tremor was observed postoperatively. Conclusions The prognosis of tremor due to posterior fossa tumors appears to depend mainly on the involvement of tremor-generating structures. The prognosis appears to be favorable in those patients with compression of these substrates, whereas primary invasion by tumor has a poor prognosis. Caution must be used in generalizing the findings of this study because of the small number of cases in the series.

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Seizure control following tumor surgery for childhood cortical low-grade gliomas

Journal of Neurosurgery ◽

10.3171/jns.1994.80.6.0998 ◽

1994 ◽

Vol 80 (6) ◽

pp. 998-1003 ◽

Cited By ~ 50

Author(s):

Roger J. Packer ◽

Leslie N. Sutton ◽

Kantilal M. Patel ◽

Ann-Christine Duhaime ◽

Steven Schiff ◽

...

Keyword(s):

Seizure Control ◽

Tumor Resection ◽

Tumor Location ◽

Seizure Outcome ◽

Low Grade ◽

Tumor Surgery ◽

Eeg Monitoring ◽

Content Type ◽

Low Grade Gliomas ◽

Seizure Foci

✓ Detailed preoperative electroencephalographic (EEG) studies are now recommended for children with seizures and cortical tumors to define seizure foci prior to surgery. To develop a historical perspective for better evaluation of results from series reporting tumor removal combined with resection of seizure foci, the authors reviewed seizure outcome in 60 children with seizures and low-grade neoplasms treated consecutively since 1981 by surgical resection without concomitant EEG monitoring or electrocortical mapping. Forty-seven of the 60 tumors were totally or near-totally resected; 45 patients were seizure-free and two were significantly improved 1 year following surgery. Of the 50 children in this series with more than five seizures prior to surgery, 36 were seizure-free, two were significantly improved, and 12 were not improved. Factors associated with poor seizure control included a parietal tumor location, a partial tumor resection, and a history of seizures for more than 1 year prior to surgery. The children at highest risk for poor seizure control at 2 years had experienced seizures for more than 1 year prior to surgery and had undergone partial resection of their parietal low-grade glial tumors or gangliogliomas. In contradistinction, the best seizure control was seen in patients with totally resected low-grade gliomas or gangliogliomas who had experienced seizures for less than 1 year (concordance rates for being seizure-free ranged from 78% to 86%). Long-term seizure control remained excellent. These results suggest that seizure control can be obtained 2 years following tumor surgery in the majority of children with presumed tumors after extensive tumor resection without concomitant EEG monitoring or electrocortical mapping.

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Comparative analysis of monotherapy versus duotherapy antiseizure drug management for postoperative seizure control in patients undergoing an awake craniotomy

Journal of Neurosurgery ◽

10.3171/2017.1.jns162913 ◽

2018 ◽

Vol 128 (6) ◽

pp. 1661-1667 ◽

Cited By ~ 4

Author(s):

Chikezie I. Eseonu ◽

Francisco Eguia ◽

Oscar Garcia ◽

Peter W. Kaplan ◽

Alfredo Quiñones-Hinojosa

Keyword(s):

Logistic Regression ◽

Seizure Control ◽

Brain Lesion ◽

Tumor Resection ◽

Awake Craniotomy ◽

Seizure Outcome ◽

Monotherapy Group ◽

Seizure Rate ◽

Postoperative Seizure ◽

Craniotomy For Tumor Resection

OBJECTIVEPostoperative seizures are a common complication in patients undergoing an awake craniotomy, given the cortical manipulation during tumor resection and the electrical cortical stimulation for brain mapping. However, little evidence exists about the efficacy of postoperative seizure prophylaxis. This study aims to determine the most appropriate antiseizure drug (ASD) management regimen following an awake craniotomy.METHODSThe authors performed a retrospective analysis of data pertaining to patients who underwent an awake craniotomy for brain tumor from 2007 to 2015 performed by a single surgeon. Patients were divided into 2 groups, those who received a single ASD (the monotherapy group) and those who received 2 types of ASDs (the duotherapy group). Patient demographics, symptoms, tumor characteristics, hospitalization details, and seizure outcome were evaluated. Multivariable logistic regression was used to evaluate numerous clinical variables associated with postoperative seizures.RESULTSA total of 81 patients underwent an awake craniotomy for tumor resection of an eloquent brain lesion. Preoperative baseline characteristics were comparable between the 2 groups. The postoperative seizure rate was 21.7% in the monotherapy group and 5.7% in the duotherapy group (p = 0.044). Seizure outcome at 6 months’ follow-up was assessed with the Engel classification scale. The duotherapy group had a significantly higher proportion of seizure-free (Engel Class I) patients than the monotherapy group (90% vs 60%, p = 0.027). The length of stay was similar, 4.02 days in the monotherapy group and 4.51 days in the duotherapy group (p = 0.193). The 90-day readmission rate was higher for the monotherapy group (26.1% vs 8.5% in the duotherapy group, p = 0.044). Multivariate logistic regression showed that preoperative seizure history was a significant predictor for postoperative seizures following an awake craniotomy (OR 2.08, 95% CI 0.56–0.90, p < 0.001).CONCLUSIONSPatients with a preoperative seizure history may be at a higher risk for postoperative seizures following an awake craniotomy and may benefit from better postoperative seizure control with postoperative ASD duotherapy.

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