gms | German Medical Science

69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

Functional and epileptological outcome after surgery for long-term epilepsy associated tumors (LEATs)

Meeting Abstract

  • Daniel Delev - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Gerrit Haaker - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Julia M. Nakagawa - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Christian Scheiwe - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
  • Bernhard Steinhoff - Epilepsiezentrum Kork, Kehl-Kork, Deutschland
  • Andreas Schulze-Bonhage - Universitätsklinikum Freiburg, Abteilung für Epileptologie, Freiburg, Deutschland
  • Josef Zentner - Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV053

doi: 10.3205/18dgnc054, urn:nbn:de:0183-18dgnc0548

Published: June 18, 2018

© 2018 Delev et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Long-term epilepsy associated tumors (LEATs) are a heterogenous group of mostly benign tumors which are typically associated with drug-resistant epilepsy. The aim of the present study was to analyse the epileptological and functional outcomes in patients with pharmacoresistant epilepsy, who underwent surgical resection of LEATs.

Methods: This retrospective single-center study comprises 186 consecutive patients, who underwent resective surgery for LEAT. CD-34 status was assessed by immunohistochemistry. Preoperative diagnostic modalities, surgical treatment, histopathological evaluation, and clinical as well as epileptological outcome were analyzed. Functional outcome was measured using the NANO (Neurologic Assessment in Neuro-Oncology) scale.

Results: The mean age of onset of seizure disorder was 19 years (+/- 13 years), whereas the mean duration of epilepsy was 9 years (+/- 12 years). The histopathological examination revealed 2 angiocentric gliomas (ANET), 47 dysembryoplastic neuroepithelial tumors (DNET), 103 gangliogliomas (GG), 23 pilocytic astrocytomas, and 9 pleomorphic xanthoastrocytomas (PXA). In 18 patients, the LEATs were additionally associated with a focal cortical dysplasia (FCD) and these patients were less likely to become seizure-free after resection (p<0.001). A dual pathology in respect of LEAT and hippocampus sclerosis (HS) was found in 26 patients. Immunohistochemistry revealed a CD34-positivity significantly associated with a histological finding of ganglioglioma (p<0.001). The majority of the lesions (n=137, 74%) were located in the temporal lobe and 43 (23%) tumors involved eloquent cortex areas. Gross total resection could have been achieved in 153 (82%) patients. At last available outcome, 135 (73%) patients were seizure free (ILAE 1; Engel Ia). NANO scale evaluation was available in 136 patients. A total of 131 (95%) showed favourable functional outcome (NANO<2). 5 (4%) patients died during the follow-up period because of malignant transformation of the tumor (4 GG and 1 PXA).

Conclusion: Surgery for long-term epilepsy associated tumors provides satisfying epileptological results with favourable functional outcome in most of the cases. Association of LEAT with FCD influenced the epileptological outcome negatively. The malignisation rate is low, but as these tumors occur predominantly in young patients the complete surgical resection remains of a paramount importance for the treatment of LEATs.