Seizure outcome with surgical management of epileptogenic ganglioglioma: a study of 55 patients

Abstract

Background: Ganglioglioma is a common seizure-associated tumor, and some factors that may influence the postoperative seizure outcome have not been discussed or are controversial. The goal of this study was to observe the postoperative seizure outcome and the prognostic factors in patients with epileptogenic gangliogliomas.

Methods: In this retrospective study, 55 patients with epileptogenic gangliogliomas underwent surgery. Postoperative seizure outcome during follow-up was recorded, and possible postoperative prognostic factors were analyzed.

Results: There were 30 males and 25 females in our study. Twenty patients presented with chronic seizures. The mean age at surgery was 19.39 years, and the mean seizure duration prior to surgery was 4.47 years. Forty-three patients had complex partial seizures, 12 patients had simple partial seizures, and secondary generalization occurred in 18 patients. Brain magnetic resonance imaging (MRI) revealed 32 tumors were located in the temporal lobe and 23 in the extratemporal lobes. Intraoperative electrocorticography (ECoG) and intraoperative ultrasound (IOUS) were used in 42 and 11 patients, respectively. Gross total resection of the tumor was achieved in 42 patients (1 patient underwent reoperation), subtotal resection in 11, and partial resection in 2. Simple lesionectomy and tailored epilepsy surgery were performed in 24 and 31 patients, respectively. After a mean follow-up of 3.27 years, 48 patients, including 1 re-operated patient, were seizure free (Engel class I). None of the factors, including age at surgery, seizure duration prior to surgery, the type of seizures, use of intraoperative ECoG and IOUS, extent of tumor resection, and surgical strategy, proved to be significantly correlated with postoperative seizure outcome.

Conclusions: Surgical treatment is effective and safe for patients with epileptogenic gangliogliomas. Early surgical intervention is necessary for achieving early seizure control. Neither intraoperative ECoG nor IOUS necessarily leads to better seizure control, although the latter can be helpful in achieving complete tumor resection. Simple lesionectomy is sufficient for favorable postoperative seizure outcome.