Incidence of seizures after surgery for supratentorial meningiomas: a modern analysis

1996 ◽  
Vol 84 (3) ◽  
pp. 382-386 ◽  
Author(s):  
Bruce S. Chozick ◽  
Steven E. Reinert ◽  
Samuel H. Greenblatt
Keyword(s):  
Mr Imaging ◽  
Seizure Control ◽  
Outcome Variable ◽  
Diagnostic Model ◽  
Seizure Outcome ◽  
Chi Square ◽  
Content Type ◽  
Modern Analysis ◽  
Postoperative Hydrocephalus ◽  
Postoperative Seizure

✓ The authors have assessed the incidence of postoperative seizures in 158 patients with supratentorial meningiomas diagnosed by computerized tomography (CT) and/or magnetic resonance (MR) imaging, which theoretically should lead to early diagnosis and treatment and the potential for improved seizure outcome. Univariate chi-square and logistic regression analyses were performed on 24 independent variables against the outcome variable of occurrence of a postoperative seizure. The median duration of preoperative seizures was 1 month, considerably shorter than that found in studies conducted prior to the advent of CT and MR imaging. Of 63 patients with a history of preoperative seizures, 40 (63.5%) had complete cessation of seizures after surgery. Twelve (92.3%) of 13 patients with one to three postoperative seizures eventually achieved complete seizure control, whereas only four (40%) of 10 patients with more than three postoperative seizures achieved this result. Overall, 88.9% of patients with preoperative seizures achieved complete seizure control postoperatively. Multivariate analysis was used to identify six variables that were predictive of the occurrence of postoperative seizures: preoperative seizure history, preoperative language disturbance, extent of tumor removal, parietal location of tumor, postoperative anticonvulsant medication status, and postoperative hydrocephalus. These variables were incorporated into a diagnostic model designed to predict the risk of a postoperative seizure following meningioma surgery. On the basis of their findings, the authors conclude that earlier detection and treatment of supratentorial meningiomas improve seizure outcome in patients with preoperative epilepsy. Furthermore, an assessment of the risk of postoperative seizures may help guide decisions concerning weaning patients from anticonvulsant medications postoperatively.

Factors predictive of suboptimal seizure control following selective amygdalohippocampectomy

2002 ◽  
Vol 97 (5) ◽  
pp. 1142-1151 ◽  
Author(s):  
Aviva Abosch ◽  
Neda Bernasconi ◽  
Warren Boling ◽  
Marilyn Jones-Gotman ◽  
Nicole Poulin ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Seizure Control ◽  
Mesial Temporal Lobe Epilepsy ◽  
Class Iii ◽  
Strict Adherence ◽  
Content Type ◽  
Selective Amygdalohippocampectomy ◽  
Postoperative Seizure ◽  
Histopathological Studies ◽  
Fine Print

Object. Selective amygdalohippocampectomy (SelAH) is used in the treatment of mesial temporal lobe epilepsy (MTLE). The goal of this study was to determine factors predictive of poor postoperative seizure control (Engel Class III or IV) following SelAH. Methods. A retrospective study was conducted of 27 patients with poor seizure control postoperatively (Engel III/IV group), in comparison with 27 patients who were free from seizures after surgery (Engel I/II group). The results of electroencephalography, magnetic resonance (MR) imaging, and pathological studies were reviewed, and volumetric MR image analysis was used to compare the extent of the mesial structures that had been resected. In 56% of patients in the Engel III/IV group, significant bitemporal abnormalities were displayed on preoperative EEG studies, compared with 24% of patients in the Engel I/II group (p < 0.05). An analysis of preoperative MR images disclosed five patients (19%) in the Engel III/IV group and no patient in the Engel I/II group with normal hippocampal volumes bilaterally. Thirteen patients in the Engel III/IV group subsequently underwent either extension of the SelAH (six cases) or a corticoamygdalohippocampectomy (seven patients). Three patients from the former and one patient from the latter subgroup subsequently became seizure free (four patients total [34%]). The remaining nine patients did not improve, despite the fact that they had undergone near-total resection of mesial structures. Conclusions. The majority of patients receiving suboptimal seizure control following SelAH did not meet the criteria for unilateral MTLE, based on EEG, MR imaging, and/or histopathological studies. These patients were therefore unlikely to benefit from additional resection of mesial structures. With the benefits of modern imaging, and by strict adherence to selection criteria, SelAH can be predicted to yield excellent postoperative seizure control for nearly all patients with unilateral MTLE. There remains a subpopulation, however, that meets the criteria for MTLE, but does not become free from seizure following SelAH.

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.

Outcome after resective epilepsy surgery in the elderly

2021 ◽  
pp. 1-10
Author(s):  
Attila Rácz ◽  
Kathryn Menne ◽  
Valeri Borger ◽  
Kevin G. Hampel ◽  
Hartmut Vatter ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Epilepsy Surgery ◽  
Seizure Control ◽  
Surgical Complication ◽  
The Elderly ◽  
Neurological Deficits ◽  
Control Group ◽  
Chi Square ◽  
Postoperative Seizure

OBJECTIVE The objective of this study was to compare complications, seizures, and neuropsychological outcomes after resective epilepsy surgery in patients ≥ 60 years of age who underwent operations to younger and matched controls. METHODS Charts of 2243 patients were screened for operated patients in the authors’ center between 2000 and 2015. Patients with available postsurgical follow-up data who were operated on at the age of 60 years or older and matched (by gender, histopathology, and side of surgery) controls who were between 20 and 40 years of age at the time of surgery were included. Outcomes regarding postoperative seizure control were scored according to the Engel classification and group comparisons were performed by using chi-square statistics. RESULTS Data of 20 older patients were compared to those of 60 younger controls. Postoperative seizure control was favorable in the majority of the elderly patients (Engel classes I and II: 75% at 12 months, 65% at last follow-up), but the proportion of patients with favorable outcome tended to be larger in the control group (Engel classes I and II: 90% at 12 months, p = 0.092; 87% at last follow-up, p = 0.032, chi-square test). The surgical complication rate was higher in the elderly population (65% vs 27%, p = 0.002), but relevant persistent deficits occurred in 2 patients of each group only. Neuropsychological and behavioral assessments displayed considerable preoperative impairment and additional postoperative worsening, particularly of verbal skills, memory (p < 0.05), and mood in the elderly. CONCLUSIONS The overall favorable postsurgical outcome regarding seizure control and the moderate risk of disabling persistent neurological deficits in elderly patients supports the view that advanced age should not be a barrier per se for resective epilepsy surgery and underscores the importance of an adequate presurgical evaluation and of referral of elderly patients to presurgical assessment.

Neural network analysis of preoperative variables and outcome in epilepsy surgery

1999 ◽  
Vol 90 (6) ◽  
pp. 998-1004 ◽  
Author(s):  
Jeffrey E. Arle ◽  
Kenneth Perrine ◽  
Orrin Devinsky ◽  
Werner K. Doyle
Keyword(s):  
Neural Network ◽  
Neural Networks ◽  
Epilepsy Surgery ◽  
Multivariate Techniques ◽  
Chi Square ◽  
Content Type ◽  
Individual Variables ◽  
Postoperative Seizure ◽  
Chi Square Analysis ◽  
Fine Print

Object. Because appropriate patient selection is essential for achieving successful outcomes after epilepsy surgery, the need for more robust methods of predicting postoperative seizure control has been created. Standard multivariate techniques have been only 75 to 80% accurate in this regard. Recent use of artificial intelligence techniques, including neural networks, for analyzing multivariate clinical data has been successful in predicting medical outcome.Methods. The authors applied neural network techniques to 80 consecutive patients undergoing epilepsy surgery in whom data on demographic, seizure, operative, and clinical variables to predict postoperative seizures were collected.Neural networks could be used to predict postoperative seizures in up to 98% of cases. Student's t-tests or chi-square analysis performed on individual variables revealed that only the preoperative medication index was significantly different (p = 0.02) between the two outcome groups. Six different combinations of input variables were used to train the networks. Neural network accuracies differed in their ability to predict seizures: using all data (96%); all data minus electroencephalography concordance and operative side (93%); all data except intra- or postoperative variables such as tissue pathological category (98%); all data excluding pathological category, intelligence quotient (IQ) data, and Wada results (84%); only demographics and tissue pathological category (65%); and only IQ data (63%).Conclusions. Analysis of the results reveals that several networks that are trained with the usual accepted variables characterizing the typical evaluation of epilepsy patients can predict postoperative seizures with greater than 95% accuracy.

Gamma knife radiosurgery for hypothalamic hamartomas in patients with medically intractable epilepsy and precocious puberty

2000 ◽  
Vol 92 (4) ◽  
pp. 726-731 ◽  
Author(s):  
Frank Unger ◽  
Oskar Schröttner ◽  
Klaus Haselsberger ◽  
Eva Körner ◽  
Robert Ploier ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Gamma Knife ◽  
Precocious Puberty ◽  
Seizure Control ◽  
Gamma Knife Radiosurgery ◽  
Content Type ◽  
Hypothalamic Hamartomas ◽  
Gelastic Epilepsy ◽  
Fine Print

✓ Hamartoma of the hypothalamus represents a well-known but rare cause of central precocious puberty and gelastic epilepsy. Due to the delicate site in which the tumor is located, surgery is often unsuccessful and associated with considerable risks. In the two cases presented, gamma knife radiosurgery was applied as a safe and noninvasive alternative to obtain seizure control.Two patients, a 13-year-old boy and a 6-year-old girl, presented with medically intractable gelastic epilepsy and increasing episodes of secondary generalized seizures. Abnormal behavior and precocious puberty were also evident. Magnetic resonance (MR) imaging revealed hypothalamic hamartomas measuring 13 and 11 mm, respectively. After general anesthesia had been induced in the patients, radiosurgical treatment was performed with margin doses of 12 Gy to 90% and 60% of isodose areas, covering volumes of 700 and 500 mm3, respectively.After follow-up periods of 54 months in the boy and 36 months in the girl, progressive decrease in both seizure frequency and intensity was noted (Engel outcome scores IIa and IIIa, respectively). Both patients are currently able to attend public school. Follow-up MR imaging has not revealed significant changes in the sizes of the lesions.Gamma knife radiosurgery can be an effective and safe treatment modality for achieving good seizure control in patients with hypothalamic hamartomas.

Prognostic factors and outcome after different types of resection for temporal lobe epilepsy

2002 ◽  
Vol 97 (5) ◽  
pp. 1131-1141 ◽  
Author(s):  
Hans Clusmann ◽  
Johannes Schramm ◽  
Thomas Kral ◽  
Christoph Helmstaedter ◽  
Burkhard Ostertun ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Seizure Control ◽  
Memory Deficit ◽  
Seizure Outcome ◽  
Neuropsychological Performance ◽  
Clinical Factors ◽  
Mr Images ◽  
Content Type ◽  
Good Seizure Control ◽  
Fine Print

Object. It is unknown whether different resection strategies for temporal lobe epilepsy (TLE) produce alterations in seizure control or neuropsychological performance. Methods. A series of 321 patients who underwent surgery for TLE between 1989 and 1997 was submitted to a uniand multifactorial analysis of clinical, electrophysiological, neuroimaging, neuropsychological, and surgical factors to determine independent predictors of outcome. Until 1993, most patients with TLE underwent standard anterior temporal lobectomy (ATL); beginning in 1993, surgical procedures were increasingly restricted to lesions detected on magnetic resonance (MR) imaging and the presumed epileptogenic foci: for example, amygdalohippocampectomy (AH) or lesionectomy/corticectomy began to be used more often. The mean follow-up duration in this study was 38 months. Two hundred twenty-seven patients were classified as seizure free (70.7%), and 36 patients had rare and nondisabling seizures (11.2%); these groups were summarized as having good seizure control (81.9%). Twenty-four patients attained more than 75% improvement (7.5%), and no worthwhile improvement was seen in 34 cases (10.6%); these groups were summarized as having unsatisfactory seizure control (18.1%). On unifactorial analysis the following preoperative factors were associated with good seizure control (p < 0.05): single and concordant lateralizing focus on electroencephalography studies, low seizure frequency, absence of status epilepticus, concordant lateralizing memory deficit, clear abnormality on MR images, suspected ganglioglioma or dysembryoplastic neuroepithelial tumor (DNT), and absence of dysplasia on MR images. Stepwise logistic regression revealed a model containing five factors that were predictive for good seizure control (p < 0.1): 1) clear abnormality on MR images; 2) absence of status epilepticus; 3) MR imaging—confirmed ganglioglioma or DNT; 4) concordant lateralizing memory deficit; and 5) absence of dysplasia on MR images. Seizure outcome was mainly correlated with diagnosis and clinical factors. No significant differences were found regarding different resection types performed for comparable tumors. Neuropsychological testing revealed better postoperative results after limited resections compared with standard ATL, especially with regard to attention level, verbal memory, and calculated total neuropsychological performance. Conclusions. Different strategies for surgical approaches in TLE result in equally good outcomes. Seizure outcome is mainly dependent on the diagnosis and clinical factors, whereas the neuropsychological results are more beneficial after resections limited to an epileptogenic lesion and focus.

scholarly journals Shorter epilepsy duration is associated with better seizure outcome in temporal lobe epilepsy surgery

2015 ◽  
Vol 73 (3) ◽  
pp. 212-217 ◽  
Author(s):  
Lucas Crociati Meguins ◽  
Rodrigo Antônio Rocha da Cruz Adry ◽  
Sebastião Carlos da Silva-Junior ◽  
Gerardo Maria de Araújo Filho ◽  
Lúcia Helena Neves Marques
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Surgical Outcome ◽  
Seizure Control ◽  
Seizure Outcome ◽  
Seizure Onset ◽  
Postoperative Seizure

Objective To investigate the influence of patient’s age and seizure onset on surgical outcome of temporal lobe epilepsy (TLE). Method A retrospective observational investigation performed from a cohort of patients from 2000 to 2012. Results A total of 229 patients were included. One-hundred and eleven of 179 patients (62%) were classified as Engel I in the group with < 50 years old, whereas 33 of 50 (66%) in the group with ≥ 50 years old group (p = 0.82). From those Engel I, 88 (61%) reported epilepsy duration inferior to 10 years and 56 (39%) superior to 10 years (p < 0.01). From the total of patients not seizure free, 36 (42%) reported epilepsy duration inferior to 10 years and 49 (58%) superior to 10 years (p < 0.01). Conclusion Patients with shorter duration of epilepsy before surgery had better postoperative seizure control than patients with longer duration of seizures.

scholarly journals Seizure Outcome After Surgical Resection of Insular Glioma

Neurosurgery ◽  
2017 ◽  
Vol 83 (4) ◽  
pp. 709-718 ◽  
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.

Multimodality image-guided surgery for the treatment of medically refractory epilepsy

2004 ◽  
Vol 100 (3) ◽  
pp. 452-462 ◽  
Author(s):  
Michael A. Murphy ◽  
Terence J. O'Brien ◽  
Kevin Morris ◽  
Mark J. Cook
Keyword(s):  
Mr Imaging ◽  
Imaging Modalities ◽  
Image Guided Surgery ◽  
Seizure Outcome ◽  
Mr Image ◽  
Content Type ◽  
Guided Surgery ◽  
Image Guided ◽  
Multimodality Image ◽  
Fine Print

Object. The aim of this study was to review seizure outcome, imaging modalities used, and complications following surgery in patients with epilepsy who had undergone multimodality image-guided surgery at our institution. Methods. Data from patients with epilepsy who had undergone surgery between April 1999 and October 2001 were reviewed. During this time period, 116 operations were performed in 109 patients with medically refractory epilepsy. Among these patients, 22 were selected to undergo multimodality image-guided surgery primarily on the basis of whether they had no lesion visible on conventional magnetic resonance (MR) imaging sequences, multiple lesions, or one very large lesion that could not be completely resected without the risk of significant postoperative morbidity. A fourth group of patients in whom there was a single lesion in the eloquent cortex, a location associated with a significant risk of postoperative morbidity, was also included in the analysis. This latter group was assessed with the aid of intracranial grid electrodes that were coregistered to the MR image and were used intraoperatively to minimize electrode position error. Other imaging modalities used included positron emission tomography (PET), fluid-attenuated inversion recovery (FLAIR) MR imaging, and subtracted ictal–interictal single-photon positron emission computerized tomography (SPECT) coregistered with MR imaging (SISCOM). After coregistration, images were then downloaded onto an image-guided surgical system and the epileptogenic area was then resected. The mean patient age was 33 years (range 17–46 years), and there was a mean follow up of 27 months (range 14–41 months). Multimodality coregistrations used were as follows: nine PET scans, seven subdural electrode grids, four SISCOM studies, one FLAIR MR image, and one combined PET/subdural grid. Seizure outcome was excellent in 17 patients (77%) and not excellent in five (23%), or favorable in 19 (86%) and unfavorable in three (14%). Six patients (27%) had a transient neurological deficit, one patient (5%) a permanent major deficit, and three patients (15%) a permanent minor deficit. Five patients (24%) had a transient psychiatric problem postoperatively. Conclusions. Multimodality image-guided surgery offers a new perspective in surgery for epilepsy. Functional imaging modalities previously lateralized and often localized a seizure focus, but did not provide enough anatomical information to resect the epileptogenic zone confidently and safely. The coregistration of these modalities to a volumetric MR image and their incorporation into an image-guided system has allowed surgeons to offer surgery to patients who may not previously have been considered eligible, with outcomes comparable to those in patients with more straightforward lesional epilepsy.

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

1994 ◽  
Vol 80 (6) ◽  
pp. 998-1003 ◽  
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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