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Epilepsy surgery related to pediatric brain tumors: Miami Children's Hospital experience
Aria Fallah1,2, Alexander G Weil1, Samir Sur1
1Departments of 1 Neurosurgery and.
Insights
Epilepsy surgery for pediatric brain tumors is effective, with most patients achieving seizure freedom. Complete resection guided by electrocorticography (ECoG) and temporal lobe tumor location may improve long-term seizure control.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Epileptology
Background:
- Pediatric brain tumors can cause medically intractable epilepsy.
- Epilepsy surgery is a potential treatment for drug-resistant seizures in these children.
Purpose of the Study:
- To evaluate the effectiveness of epilepsy surgery for seizure control in pediatric patients with brain tumors.
- To identify factors predicting seizure recurrence after surgery.
Main Methods:
- Retrospective review of 84 pediatric patients undergoing resective epilepsy surgery for brain tumors (1986-2014).
- Time-to-event analysis for seizure recurrence, with "event" defined as post-operative seizures (excluding the first week).
- Analysis of preoperative variables for prediction of seizure recurrence.
Main Results:
- 78% of patients achieved Engel Class I outcome at 1 year, and 75% at 2 years.
- Gangliogliomas, dysembryoplastic neuroepithelial tumors (DNETs), and gliomas showed varying probabilities of long-term seizure freedom.
- Intraoperative electrocorticography (ECoG) guided 94% of resections. Temporal lobe location and complete resection showed trends toward better outcomes.
Conclusions:
- ECoG-guided epilepsy surgery is highly effective for seizure control in pediatric brain tumor patients.
- Complete resection and temporal lobe tumor location may enhance the likelihood of long-term seizure freedom.
Object:
Pediatric brain tumors may be associated with medically intractable epilepsy for which surgery is indicated. The authors sought to evaluate the efficacy of epilepsy surgery for seizure control in pediatric patients with brain tumors.
Methods:
The authors performed a retrospective review of consecutive patients undergoing resective epilepsy surgery related to pediatric brain tumors at Miami Children's Hospital between June 1986 and June 2014. Time-to-event analysis for seizure recurrence was performed; an "event" was defined as any seizures that occurred following resective epilepsy surgery, not including seizures and auras in the 1st postoperative week. The authors analyzed several preoperative variables to determine their suitability to predict seizure recurrence following surgery.
Results:
Eighty-four patients (47 males) with a mean age (± standard deviation) of 8.7 ± 5.5 years (range 0.5-21.6 years) were included. The study included 39 (46%) patients with gliomas, 20 (24%) with dysembryoplastic neuroepithelial tumors (DNETs), 14 (17%) with gangliogliomas, and 11 (13%) with other etiologies. Among the patients with gliomas, 18 were classified with low-grade glioma, 5 had oligodendroglioma, 6 had uncategorized astrocytoma, 3 had pilocytic astrocytoma, 3 had pleomorphic xanthoastrocytoma, 3 had glioblastoma, and 1 had gliomatosis cerebri. Seventy-nine (94.0%) resections were guided by intraoperative electrocorticography (ECoG). The mean time (± standard deviation) to seizure recurrence was 81.8 ± 6.3 months. Engel Class I outcome was achieved in 66 (78%) and 63 (75%) patients at 1 and 2 years' follow-up, respectively. Patients with ganglioglioma demonstrated the highest probability of long-term seizure freedom, followed by patients with DNETs and gliomas. In univariate analyses, temporal location (HR 1.75, 95% CI 0.26-1.27, p = 0.171) and completeness of resection (HR 1.69, 95% CI 0.77-3.74, p = 0.191) demonstrated a trend toward a longer duration of seizure freedom.
Conclusions:
ECoG-guided epilepsy surgery for pediatric patients with brain tumors is highly effective. Tumors located in the temporal lobe and those in which a complete ECoG-guided resection is performed may result in a greater likelihood of long-term seizure freedom.