Temporal lobe ganglioglioma in refractory epilepsy: CT and MR in three cases

Three patients (ages 5, 16 and 21 years) with chronic, refractory, partial epilepsy and temporal lobe ganglioglioma were evaluated for surgical treatment. Noncontrast CT revealed a low attenuation, cystic temporal lesion in 2 patients. One neoplasm demonstrated focal calcification and temporal altrophy, while the other had mass effect and surrounding edema. Contrast enhancement of the mass was seen in one instance. Non-contrast and post-contrast CT were completely normal in the remaining patient. MR was abnormal in both patients in which it was performed (including the patient with a normal CT examination). Lesions were hyperintense on T2W inmages and iso-to-hypointense on T1W images when compared to normal parenchyma. Regions of calcification were missed on standard spin-echo sequences. Continuous video EEG monitoring captured habitual partial seizures in all patients; focal onset correlated with tumor location in each instance. Intraoperative electrocorticography corroborated the EEG results. Two of three patients underwent gross total resection. Pathologic features were characteristic of ganglioglioma in all instances. All patients have been seizure-free postoperatively [mean follow-up: 16 months (range 13-18 months)] and without evidence of tumor recurrence. Although ganglioglioma is an unusual cause of refractory temporal lobe epilepsy, our short term follow-up suggests excellent outcome with both partial and gross total resection.