Surgery for the treatment of low-grade glioma secondary epilepsy−analysis of 45 cases_Journal of Epilepsy

Authors：

 WANG Huanming , HU Fei , CHEN Jun , XIAO Kai , XIONG Yubo , CHEN Yang , YANG Chongyang , TU Shengxu

Department of Neurosurgery, Wuhan Brain Hospital & Changhang General Hospital, Wuhan 430010, China;

Corresponding author：

WANG Huanming, Email: 1808381741@qq.com

Keywords：

Low-grade glioma; Epilepsy; Electrocorticography; Surgery

DOI：

10.7507/2096-0247.20210082

Video：

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Objective To explore the clinical characteristics and surgical effect of low-grade glioma (LGG) secondary epilepsy.Methods 45 cases of low-grade glioma secondary epilepsy were retrospectively studied during December 2010 and December 2020.There were 27 males and 18 females in this group. Their ages ranged from 10 to 69 years [mean (42.8±15.61) years]. And the illness duration ranged from 3 months to 5 years [mean (12.5±4.12) months]. The initial manifestation of all LGG was seizure attack.All the patients underwent CT and MRI examination before the operation. The LGG was located in the frontal lobe in 17 cases, temporal lobe in 8 cases, parietal lobe in 4 cases, frontal-temporal lobe in 7 cases, frontal-parietal lobe in 5 cases. Meanwhile the LGG was located in the left side in 31 cases, right side in 14 cases. The long-term video-EEG monitoring showed the epileptogenic lesion was located in the ispilateral frontal lobe in 20 cases, temporal lobe in 8 cases, frontal-temporal lobe in 12 cases, frontal-parietal lobe in 5 cases.All the patients were performed operation under the intra-operative electrocorticography (ECoG) monitoring.If necessary, enlarged epileptogenic cortical resection, cortical coagulation or MST was added.After the operation, all the patients were followed-up for half a year to 10 years [mean (4.7±1.83) years] to observe the surgical effect.Results 42 cases of LGG underwent gross total resection and 3 subtotal resection intra-operatively. Anterial temporal lobectomy (ALT) was added in 19 cases whose LGG were invovled with temporal lobe.13 cases were added cortical cogulation and 5 cases MST.The post-operative pathology showed astrocytoma grade Ⅰin 20 cases, astrocytoma grade Ⅱ in 12 cases, oligodendroglioma in 11 cases and dysembryoplastic neuroepithelial tumor (DNET) in 2 cases. The post-operative follow-up showed that 30 cases lived well, 12 cases recurred and received re-operation, 3 cases died. Meanwhile, 42 cases were seizure free and 3 cases had occasional seizure attack during the follow-up.Conclusions To the patients with LGG secondary epilepsy, if pre-operative long-term EEG monitoring is in accordance with imaging examination, early LGG resection combined with epileptogenic lesion resection should be performed under the guidance of ECoG monitoring.And the post-operative effect is satisfactory.

Citation： WANG Huanming, HU Fei, CHEN Jun, XIAO Kai, XIONG Yubo, CHEN Yang, YANG Chongyang, TU Shengxu. Surgery for the treatment of low-grade glioma secondary epilepsy−analysis of 45 cases. Journal of Epilepsy, 2021, 7(6): 500-504. doi: 10.7507/2096-0247.20210082 Copy

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2.	Kemerdere R, Yuksel O, Kacira T, et al. Low-grade temporal gliomas: surgical strategy and long-term seizure outcome. Clin Neurol Neurosurg, 2014, 126: 196-200.
3.	Lombardi D, Marsh R, Tribolet N. Low grade glioma in intractable epilepsy: lesionectomy versus epilepsy surgery. Acta Neurochir Suppl, 1997, 68: 70-74.
4.	Brown MT, Boop FA. Epilepsy surgery for pediatric low-grade gliomas of the cerebral hemispheres: neurosurgical considerations and outcomes. Childs Nerv Syst, 2016, 32(10): 1923-1930.
5.	Beaumont A, Whittle IR. The pathogenesis of tumour associated epilepsy. Acta Neurochir(Wien), 2000, 142(1): 1-15.
6.	Slegers RJ, Blumcke I. Low-grade developmental and epilepsy associated brain tumors: a critical update 2020. Acta Neuropathol Commun, 2020, 8(1): 27.
7.	Tanya IY, Andrew PM, Andrew B, et al. Glutamate is associated with a higher risk of seizures in patients with gliomas. Neurology, 2012, 79(9): 883-889.
8.	Florian S, Martin M, Hans-Joachim H, et al. IDH1/2 mutations in WHO grade II astrocytomas associated with localization and seizure as the initial symptom. Seizure, 2012, 21(3): 194-197.
9.	Cardamone M, Flanagan D, Mowat D, et al. Mammalian target of rapamycin inhibitors for intractable epilepsy and subependymal giant cell astrocytomas in tuberous sclerosis complex. J Pediatr, 2014, 164(5): 1195-1200.
10.	Rosati A, Tomassini A, Pollo B, et al. Epilepsy in cerebral glioma: timing of appearance and histological correlations. J Neurooncol, 2009, 93(3): 395-400.
11.	Englot DJ, Chang EF, Vecht CJ. Epilepsy and brain tumors. Handb Clin Neurol, 2016, 134: 267-285.
12.	Yao PS, Zheng SF, Wang F, et al. Surgery guided with intraoperative electrocorticography in patients with low-grade glioma and refractory seizures. J Neurosurg, 2018, 128(3): 840-845.
13.	Chaichana KL, Parker SL, Olivi A, et al. Long-term seizure outcomes in adult patients undergoing primary resection of malignant brain astrocytomas. J Neurosurg, 2009, 111(2): 282-292.
14.	Chang EF, Potts MB, Keles GE, et al. Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg, 2008, 108(2): 227-235.
15.	Ko A, Kim SH, Kim SH, et al. Epilepsy surgery for children with low-grade epilepsy-associated tumors: factors associated with seizure recurrence and cognitive function. Pediatr Neurol, 2019, 91: 50-56.

1. Pallud J, McKhann GM. Diffuse low-grade glioma-related epilepsy. Neurosurg Clin N Am, 2019, 30(1): 43-54.
2. Kemerdere R, Yuksel O, Kacira T, et al. Low-grade temporal gliomas: surgical strategy and long-term seizure outcome. Clin Neurol Neurosurg, 2014, 126: 196-200.
3. Lombardi D, Marsh R, Tribolet N. Low grade glioma in intractable epilepsy: lesionectomy versus epilepsy surgery. Acta Neurochir Suppl, 1997, 68: 70-74.
4. Brown MT, Boop FA. Epilepsy surgery for pediatric low-grade gliomas of the cerebral hemispheres: neurosurgical considerations and outcomes. Childs Nerv Syst, 2016, 32(10): 1923-1930.
5. Beaumont A, Whittle IR. The pathogenesis of tumour associated epilepsy. Acta Neurochir(Wien), 2000, 142(1): 1-15.
6. Slegers RJ, Blumcke I. Low-grade developmental and epilepsy associated brain tumors: a critical update 2020. Acta Neuropathol Commun, 2020, 8(1): 27.
7. Tanya IY, Andrew PM, Andrew B, et al. Glutamate is associated with a higher risk of seizures in patients with gliomas. Neurology, 2012, 79(9): 883-889.
8. Florian S, Martin M, Hans-Joachim H, et al. IDH1/2 mutations in WHO grade II astrocytomas associated with localization and seizure as the initial symptom. Seizure, 2012, 21(3): 194-197.
9. Cardamone M, Flanagan D, Mowat D, et al. Mammalian target of rapamycin inhibitors for intractable epilepsy and subependymal giant cell astrocytomas in tuberous sclerosis complex. J Pediatr, 2014, 164(5): 1195-1200.
10. Rosati A, Tomassini A, Pollo B, et al. Epilepsy in cerebral glioma: timing of appearance and histological correlations. J Neurooncol, 2009, 93(3): 395-400.
11. Englot DJ, Chang EF, Vecht CJ. Epilepsy and brain tumors. Handb Clin Neurol, 2016, 134: 267-285.
12. Yao PS, Zheng SF, Wang F, et al. Surgery guided with intraoperative electrocorticography in patients with low-grade glioma and refractory seizures. J Neurosurg, 2018, 128(3): 840-845.
13. Chaichana KL, Parker SL, Olivi A, et al. Long-term seizure outcomes in adult patients undergoing primary resection of malignant brain astrocytomas. J Neurosurg, 2009, 111(2): 282-292.
14. Chang EF, Potts MB, Keles GE, et al. Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg, 2008, 108(2): 227-235.
15. Ko A, Kim SH, Kim SH, et al. Epilepsy surgery for children with low-grade epilepsy-associated tumors: factors associated with seizure recurrence and cognitive function. Pediatr Neurol, 2019, 91: 50-56.

Journal of Epilepsy

Surgery for the treatment of low-grade glioma secondary epilepsy−analysis of 45 cases

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