ABSTRACT
To explore the factors associated with preoperative epileptic seizure and surgical outcome in patients with cerebral gangliolioma [GG]. A total of 31 consecutive patients with pathologically confirmed ganglioglioma and surgically treated from January 2003 to June 2011 in West China Hospital of Sichuan University were retrospectively reviewed. Clinical data, surgical procedure and follow-up information were collected and analyzed. Nineteen patients presented with epileptic seizure, of which 63.2% were males. The mean age at epilepsy surgery and mean seizure duration were 25.6 years and 2.3 years respectively. Factors associated with preoperative epileptic seizure were supratentorial lesion and temporal lobe involvement [p=0.016 and 0.008]. Intraoperative electrocorticography [ECoG] was applied in 8 out of 19 epilepsy patients. Eighteen achieved total tumor excision. After a mean follow up of 2.8 [1.3-6.3] years, 11 [68.8%, 11/16] achieved seizure free [Engel class I]. Early surgery [seizure duration < 3 years] was a significant predictor of favorable seizure outcome [p=0.013]. None of the factors including seizure type, tumor location, neuroimaging characteristics and application of intraoperative ECoG or surgical strategy were found to be significantly associated with postoperative seizure outcome. Postoperative combination of AEDs was unnecessary for seizure control. Ganglioglioma with temporal lobe involvement usually associated with intractable epilepsy. Early surgical resection is strongly suggested to achieve favorable outcome. Intraoperative ECoG is not inevitable and simple lesionectomy is sufficient for satisfactory seizure control. Early accurate diagnosis of ganglioglioma should be established on comprehensive consideration and plays an important role in dealing with these patients
ABSTRACT
Objective: To explore the factors associated with preoperative and postoperative epileptic seizure in patients with cavernous malformations [CMs]
Methods: A total of 52 consecutive patients from January 2009 to June 2011 who underwent surgical treatment in West China Hospital of Sichuan University due to CMs and confirmed by histopathology were retrospectively reviewed.Patients were divided into two groups [epilepsy-group and non-epilepsy group] according to clinical presentation. Other clinical data, treatment procedure, and follow-up information were collected. Engel classification was used to evaluate seizure outcome
Results: Low birth weight, temporal lobe involvement and cortical lesion showed significant difference between two groups [p=0.017, 0.003 and 0.025 respectively]. Cortical lesion highly increased risk for preoperative epileptic seizure [OR=10.48; 95% CI 1.61-68.23]. After a mean follow-up of 2.1 years, 77.8% of epileptic patients achieved Engel class I. Temporal lobe involvement, lesion size < 2.5cm and surgery within one year of symptom onset were found associated with better seizure outcome [p=0.016, 0.012 and 0.050]. Temporal lobe involvement significantly decreased the risk for postoperative epileptic seizure [OR=0.038; 95% CI 0.002-0.833]. Application of ECoG made no significant difference to seizure outcome [p=0.430]. Most patients need continuing medication therapy after surgery
Conclusion: Surgical treatment of patient with CMs is satisfactory in most cases and temporal lobe involvement usually predict favourable postoperative seizure outcome whether under the monitoring of ECoG or not. Thus, epileptic patients with CMs should be considered for surgical treatment especially when cortical brain layer or temporal lobe was involved