Seizure characteristics and control following resection in 332 patients with low-grade gliomas

2008 ◽  
Vol 108 (2) ◽  
pp. 227-235 ◽  
Author(s):  
Edward F. Chang ◽  
Matthew B. Potts ◽  
G. Evren Keles ◽  
Kathleen R. Lamborn ◽  
Susan M. Chang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Seizure Control ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Low Grade ◽  
Total Resection ◽  
Meaningful Improvement ◽  
Low Grade Gliomas ◽  
Initial Surgery ◽  
Postoperative Seizure

Object Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control. Methods The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003. Results Three hundred and thirty-two cases were included for analysis; 269 (81%) of the 332 patients presented with ≥ 1 seizures (generalized alone, 33%; complex partial alone, 16%; simple partial alone, 22%; and combination, 29%). Cortical location and oligodendroglioma and oligoastrocytoma subtypes were significantly more likely to be associated with seizures compared with deeper midline locations and astrocytoma, respectively (p = 0.017 and 0.001, respectively; multivariate analysis). Of the 269 patients with seizures, 132 (49%) had pharmacoresistant seizures before surgery. In these patients, seizures were more likely to be simple partial and to involve the temporal lobe, and the period from seizure onset to surgery was likely to have been longer (p = 0.0005, 0.0089, and 0.006, respectively; multivariate analysis). For the cohort of patients that presented with seizures, 12-month outcome after surgery (Engel class) was as follows: seizure free (I), 67%; rare seizures (II), 17%; meaningful seizure improvement (III), 8%; and no improvement or worsening (IV), 9%. Poor seizure control was more common in patients with longer seizure history (p < 0.001) and simple partial seizures (p = 0.004). With respect to treatment-related variables, seizure control was far more likely to be achieved after gross-total resection than after subtotal resection/biopsy alone (odds ratio 16, 95% confidence interval 2.2–124, p = 0.0064). Seizure recurrence after initial postoperative seizure control was associated with tumor progression (p = 0.001). Conclusions The majority of patients with LGG present with seizures; in approximately half of these patients, the seizures are pharmacoresistant before surgery. Postoperatively, > 90% of these patients are seizure free or have meaningful improvement. A shorter history of seizures and gross-total resection appear to be associated with a favorable prognosis for seizure control.

scholarly journals Seizures in Patients Undergoing Resection of Low-Grade Gliomas

2009 ◽  
Vol 9 (4) ◽  
pp. 98-100 ◽  
Author(s):  
Lawrence J. Hirsch
Keyword(s):  
Multivariate Analysis ◽  
Seizure Control ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Low Grade ◽  
Total Resection ◽  
Meaningful Improvement ◽  
Low Grade Gliomas ◽  
Initial Surgery ◽  
Postoperative Seizure

Seizure Characteristics and Control Following Resection in 332 Patients with Low-Grade Gliomas. Chang EF, Potts MB, Keles GE, Lamborn KR, Chang SM, Barbaro NM, Berger MS. J Neurosurg 2008;108(2):227–235. OBJECT: Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control. METHODS: The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003. RESULTS: Three hundred and thirty-two cases were included for analysis; 269 (81%) of the 332 patients presented with ≥1 seizures (generalized alone, 33%; complex partial alone, 16%; simple partial alone, 22%; and combination, 29%). Cortical location and oligodendroglioma and oligoastrocytoma subtypes were significantly more likely to be associated with seizures compared with deeper midline locations and astrocytoma, respectively ( p = 0.017 and 0.001, respectively; multivariate analysis). Of the 269 patients with seizures, 132 (49%) had pharmacoresistant seizures before surgery. In these patients, seizures were more likely to be simple partial and to involve the temporal lobe, and the period from seizure onset to surgery was likely to have been longer ( p = 0.0005, 0.0089, and 0.006, respectively; multivariate analysis). For the cohort of patients that presented with seizures, 12-month outcome after surgery (Engel class) was as follows: seizure free (I), 67%; rare seizures (II), 17%; meaningful seizure improvement (III), 8%; and no improvement or worsening (IV), 9%. Poor seizure control was more common in patients with longer seizure history ( p < 0.001) and simple partial seizures ( p = 0.004). With respect to treatment-related variables, seizure control was far more likely to be achieved after gross-total resection than after subtotal resection/biopsy alone (odds ratio 16, 95% confidence interval 2.2–124, p = 0.0064). Seizure recurrence after initial postoperative seizure control was associated with tumor progression ( p = 0.001). CONCLUSIONS: The majority of patients with LGG present with seizures; in approximately half of these patients, the seizures are pharmacoresistant before surgery. Postoperatively, > 90% of these patients are seizure free or have meaningful improvement. A shorter history of seizures and gross-total resection appear to be associated with a favorable prognosis for seizure control.

Predictors of seizure freedom after resection of supratentorial low-grade gliomas

2011 ◽  
Vol 115 (2) ◽  
pp. 240-244 ◽  
Author(s):  
Dario J. Englot ◽  
Mitchel S. Berger ◽  
Nicholas M. Barbaro ◽  
Edward F. Chang
Keyword(s):  
Seizure Control ◽  
Critical Factor ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Low Grade ◽  
Total Resection ◽  
Low Grade Gliomas ◽  
Seizure Semiology

Object Seizures are the most frequent presenting symptom in patients with low-grade gliomas (LGGs), and significantly influence quality of life if they are uncontrolled. Achieving freedom from seizures is of utmost importance in surgical planning, but the factors associated with seizure control remain incompletely understood. Methods The authors performed a systematic literature review of seizure outcomes after resection of LGGs causing seizures, examining 773 patients across 20 published series. Rates of seizure freedom were stratified across 7 variables: patient age, tumor location, preoperative seizure control with medication, seizure semiology, epilepsy duration, extent of resection, and the use of intraoperative electrocorticography (ECoG). Results Gross-total resection was most predictive of complete seizure freedom, when compared with subtotal resection (OR 3.41, 95% CI 2.36–4.93). Other predictors of seizure freedom included preoperative seizure control on antiepileptic medication (OR 2.12, 95% CI 1.33–3.38) and duration of seizures of ≤ 1 year (OR 1.85, 95% CI 1.22–2.79). Patients with simple partial seizure semiology achieved seizure freedom less often than those with complex partial, generalized, or mixed seizure types (OR 0.46, 95% CI 0.26–0.80). No significant differences in seizure outcome were observed between adults versus children, patients with temporal lobe versus extratemporal tumors, or with the use of intraoperative ECoG. Conclusions Seizure control is one of the most important considerations in planning surgery for low-grade brain tumors. Gross-total resection is a critical factor in achieving seizure freedom.

scholarly journals Intracranial Low Grade Glioma: a Clinical Study of 35 Cases in a Teaching Institute

2019 ◽  
Vol 23 (4) ◽  
Author(s):  
GOHAR ALI ◽  
SOHAIL AMIR ◽  
KHALID MEHMOOD ◽  
AEEM-UL- HAQ
Keyword(s):  
Surgical Outcome ◽  
Seizure Control ◽  
Low Grade Glioma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Low Grade ◽  
Karnofsky Performance Score ◽  
Karnofsky Score ◽  
Total Resection ◽  
Number Of Patients

Objective: To determine the clinical manifestation and surgical outcome of patients with low grade Glioma.Material and Methods: This descriptive (cross sectional) study was done at the Neurosurgery Department, Mardan Medical Complex Mardan. The study period was March 2017 to February 2018. Patient of any age and gender presented to outpatient department or referred from some other medical facility and diagnosed as low grade Glioma on clinical and radiological grounds and later confirmed by histopathology were included. Results: Out of 35 patients, 20 (57%) were male and 15 (42%) were female. 20 to 80 years was the age range and mean age was 46.36 ± 17.11 years. Frontal lobe was the most frequent area of location, followed by parietal 9 (25%) and temporal 8 (22%) lobe. Pre-operativeKarnofsky score was 90 in 16 (45%), 80 in 8 (22%), 70 in 6 (17%) and 60 in 5 (14%) of patients. Gross total resection was achieved in 13 (37%), radical subtotal resection in 10 (28%), subtotal resection in 10 (28%) and biopsy taken in 02 (5%) patients. histopathology revealed Astrocytoma in 15 (42%), mixed Oligoastrocytoma in 12 (34%) and Oligodendroglioma in 8 (22%) number of patients. Post operatively surgical outcome was measured by improvement in symptomatology, Karnofsky score and seizure control. Conclusion: Conscious level, Karnofsky Performance score, seizure control are important parameters for surgical outcome in patients with low grade Gliomas. Gross total resection of the tumor is a better option for good surgical outcome.

scholarly journals Profound hearing loss following surgery in pediatric patients with posterior fossa low-grade glioma

2017 ◽  
Vol 5 (2) ◽  
pp. 96-103 ◽  
Author(s):  
Yahya Ghazwani ◽  
Ibrahim Qaddoumi ◽  
Johnnie K Bass ◽  
Shengjie Wu ◽  
Jason Chiang ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Posterior Fossa ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Low Grade Glioma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Low Grade ◽  
Total Resection ◽  
Profound Hearing Loss

Abstract Background Hearing loss may occur in patients with posterior fossa low-grade glioma who undergo surgery. Methods We retrospectively reviewed 217 patients with posterior fossa low-grade glioma, including 115 for whom results of hearing tests performed after surgery and before chemotherapy or radiation therapy were available. We explored the association of UHL with age at diagnosis, sex, race, tumor location, extent of resection, posterior fossa syndrome, ventriculoperitoneal shunt placement, and histology. Results Of the 115 patients, 15 (13.0%: 11 male, 6 black, 8 white, 1 multiracial; median age 7 years [range, 1.3–17.2 years]) had profound UHL after surgery alone or before receiving ototoxic therapy. Median age at tumor diagnosis was 6.8 years (range, 0.7–14.1 years), and median age at surgery was 6.8 years (range, 0.7–14.1 years). Patients with UHL had pathology characteristic of pilocytic astrocytoma (n = 10), ganglioglioma (n = 4), or low-grade astrocytoma (n = 1). Of these 15 patients, 4 underwent biopsy, 1 underwent gross total resection, 1 underwent near-total resection, and 9 underwent subtotal resection. UHL was more frequent in black patients than in white patients (OR 7.3, P = .007) and less frequent in patients who underwent gross total resection or near-total resection than in those who underwent subtotal resection (OR 0.11, P = .02). Conclusions Children undergoing surgery for posterior fossa low-grade glioma are at risk for UHL, which may be related to race or extent of resection. These patients should receive postoperative audiologic testing, as earlier intervention may improve outcomes.

scholarly journals LG-48PAEDIATRIC LOW GRADE GLIOMAS - IMPACT OF GROSS TOTAL RESECTION IN A SINGLE CENTRE COHORT

2016 ◽  
Vol 18 (suppl 3) ◽  
pp. iii89.3-iii89
Author(s):  
Noelle Cullinan ◽  
John Caird ◽  
Michael Capra ◽  
Jane Pears ◽  
Cormac Owens ◽  
...  
Keyword(s):  
Gross Total Resection ◽  
Low Grade ◽  
Single Centre ◽  
Total Resection ◽  
Low Grade Gliomas

Seizure Characteristics and Postoperative Seizure Control in Patients with Low-grade Gliomas

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. 430-430 ◽  
Author(s):  
Edward F. Chang ◽  
Evren G. Keles ◽  
Matt Potts ◽  
Susan Chang ◽  
Kathleen L. Lamborn ◽  
...  
Keyword(s):  
Seizure Control ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Postoperative Seizure

Long-term Seizure Control Outcomes After Resection of Gangliogliomas

Neurosurgery ◽  
2012 ◽  
Vol 70 (6) ◽  
pp. 1406-1414 ◽  
Author(s):  
Derek G. Southwell ◽  
Paul A. Garcia ◽  
Mitchel S. Berger ◽  
Nicholas M. Barbaro ◽  
Edward F. Chang
Keyword(s):  
Tumor Progression ◽  
Seizure Control ◽  
Intractable Epilepsy ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Total Resection ◽  
History Of

Abstract BACKGROUND: Gangliogliomas are rare glioneuronal tumors that typically cause refractory seizures during the first 3 decades of life. OBJECTIVE: To determine the prognosticators of seizure outcome after surgery for ganglioglioma. METHODS: We reviewed the cases of 66 patients who underwent resection of gangliogliomas at the University of California, San Francisco. Demographic, seizure history, and operative data were examined for statistical association with postoperative seizure outcomes. RESULTS: Of the 66 patients who underwent surgical resection of ganglioglioma, 49 patients (74%) presented with a history of seizures. Of those 49 patients, 50% presented with intractable epilepsy. Temporal lobe gangliogliomas were present in 76% of the patients who presented with a history of seizures. Electrocorticography was performed on 35% of the patients, and of those patients, 82% underwent extended lesionectomy to remove abnormally epileptogenic extralesional tissue. The median follow-up duration was 6.9 years, during which tumor progression occurred in 38% of patients who underwent subtotal resection and in 8% of patients who underwent gross total resection (P = .02). Overall, 85% of patients were seizure free (International League Against Epilepsy class I or II) 5 years after surgery. Subtotal resection was associated with poor seizure outcomes 1 year after resection (odds ratio = 14.6; 95% confidence interval = 2.4-87.7): rates of seizure freedom were 54% after subtotal resection, 96% after gross total resection, and 93% after gross total resection with intraoperative electrocorticography-guided extended lesionectomy. CONCLUSION: We report excellent long-term seizure control outcomes after surgery for gangliogliomas. Intraoperative electrocorticography may be a useful adjunct for guiding extended resection in certain pharmacoresistant epilepsy patients with gangliogliomas. Subtotal resection is associated with higher rates of tumor progression and nonoptimal seizure outcomes.

scholarly journals Gross-total resection of temporal low grade gliomas is a critically important factor in achieving seizure-freedom

2015 ◽  
Vol 73 (11) ◽  
pp. 924-928 ◽  
Author(s):  
Lucas Crociati Meguins ◽  
Rodrigo Antônio Rocha da Cruz Adry ◽  
Sebastião Carlos da Silva Júnior ◽  
Carlos Umberto Pereira ◽  
Jean Gonçalves de Oliveira ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Gross Total Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Low Grade ◽  
Total Resection ◽  
Low Grade Gliomas ◽  
Significant Difference ◽  
The Mean ◽  
One Year

Objective To present a surgical series of patients with low grade temporal gliomas causing intractable epilepsy, focusing on long-term seizure outcome.Method A retrospective study was conducted with patients with temporal low-grade gliomas (LGG).Results Sixty five patients with were operated in our institution. Males were more affected than females and the mean age at surgery was 32.3 ± 8.4 (9-68 years). The mean age at seizure onset was 25.7 ± 9.2 (11-66 years). Seizure outcome was classified according with Engel classification. After one year of follow up, forty two patients (64.6%) were Engel I; seventeen (26.2%) Engel II; four (6.2%) Engel III and two (3.1%) Engel IV. Statistically significant difference in seizure outcome was obtained when comparing the extension of resection. Engel I was observed in 39 patients (69.6%) with total resection and in only 3 (33.3%) patients with partial resection.Conclusion Gross-total resection of temporal LGGs is a critically important factor in achieving seizure-freedom.

Repeated operations for infiltrative low-grade gliomas without intervening therapy

2003 ◽  
Vol 98 (6) ◽  
pp. 1165-1169 ◽  
Author(s):  
Meic H. Schmidt ◽  
Mitchel S. Berger ◽  
Kathleen R. Lamborn ◽  
Ken Aldape ◽  
Michael W. McDermott ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Median Time ◽  
Initial Diagnosis ◽  
Gross Total Resection ◽  
Low Grade ◽  
Total Resection ◽  
Content Type ◽  
Low Grade Gliomas ◽  
Second Surgery ◽  
Fine Print

Object. Progression of infiltrative low-grade gliomas (LGGs) has been reported previously. The limitations of such studies include diverse histological grading systems, intervening therapy, and the lack of histological confirmation of malignant tumor progression. The aim of this study was to determine tumor progression in adult patients with an initial diagnosis of infiltrative LGG who subsequently underwent a repeated operation, but no other intervening therapy. The authors examined factors that may be associated with tumor progression. Methods. The authors retrospectively reviewed a database of 300 patients with the initial diagnosis of LGG and who had been treated at their institution between 1990 and 2000. One hundred four of these patients had undergone a second surgery. Patients with infiltrative LGGs who had undergone two surgical procedures at least 3 months apart without intervening therapy were selected; the authors identified 40 patients who fit these criteria. Clinical, neuroimaging, and pathological data were centrally reviewed. There were 29 men and 11 women in the study, whose median age was 35.5 years (range 23–48 years). At the time of the second surgery, 50% of patients had experienced tumor progression. Patients whose tumors had progressed had a longer median time to repeated operation (49 compared with 22.5 months). Patients who had undergone gross-total resection, as demonstrated on postoperative magnetic resonance images, had a median time to repeated operation of 49 compared with 25 and 24 months in patients who underwent subtotal resection and biopsy, respectively (p = 0.02). The extent of resection did not influence the likelihood of tumor progression (p > 0.3). Conclusions. Fifty percent of patients with initially diagnosed infiltrative LGGs had tumor progression at the time of a repeated operation. A gross-total resection was associated with an increased time to repeated surgery. There was no statistically significant effect of gross-total resection as a predictor of tumor progression.

Sign in / Sign up

Export Citation Format

Share Document