Abstract
BackgroundLow-grade epilepsy-associated neuroepithelial tumor (LEAT) is highly responsive to surgery in general. The appropriate surgical strategy remains controversial in temporal LEAT. The aim of this study is to analyze the surgical seizure outcome of temporal LEAT, focusing on the aspects of surgical strategy.MethodsSixty-one patients from a single epilepsy center with temporal LEAT underwent surgery. The surgical strategy was according to the multidisciplinary presurgical evaluation. Electrocorticogram (ECoG)-assisted resection was utilized. Surgical extent including lesionectomy and extended resection was described in detail. Seizure outcome was classified as satisfactory (Engel class I) and unsatisfactory (Engel classes II–IV).ResultsAfter a median follow-up of 36.0 (30.0) months, 83.6% of patients achieved satisfactory outcome, including 72.1% with Engel class Ia. There was 39.3% (24/61) of patients with antiepileptic drug (AED) withdrawal. Use of ECoG (χ2 = 0.000, P > 0.1), preresection spike (χ2 = 0.000, P = 0.763), or spike residue (P = 0.545) was not correlated with the seizure outcome. For lateral temporal LEAT, outcome from lesionectomy was comparable to extended resection (χ2 = 0.499, P > 0.1). For mesial temporal LEAT, 94.7% (18/19) of patients who underwent additional hippocampectomy were satisfactory, whereas only 25% (1/4) of patients who underwent lesionectomy were satisfactory (P = 0.009).ConclusionSurgical treatment was highly effective for temporal LEAT. ECoG may not influence the seizure outcome. For lateral temporal LEAT, lesionectomy with or without cortectomy was sufficient in most patients. For mesial temporal LEAT, extended resection was recommended.
Highlights
Low-grade epilepsy-associated neuroepithelial tumors (LEAT) are the second-largest histopathological category in epilepsy surgery, just after hippocampal sclerosis [1]
Three patients lost during follow-up and 25 patients with extratemporal lobe LEAT were excluded
Among the 23 patients with mesial temporal LEAT, 94.7% (18/19) of patients got satisfactory seizure outcome with hippocampectomy, while only 25.0% (1/4) of patients achieved satisfactory seizure outcome without hippocampectomy (P = 0.009) (Table 4)
Summary
Low-grade epilepsy-associated neuroepithelial tumors (LEAT) are the second-largest histopathological category in epilepsy surgery, just after hippocampal sclerosis [1]. LEAT comprises glioneuronal tumor and low-grade glial tumor [2, 3]. Glioneuronal tumor such as ganglioglioma (GG) and dysembryoplastic neuroepithelial tumor (DNET) are the most common types [4,5,6]. Low-grade epilepsy-associated neuroepithelial tumor (LEAT) is highly responsive to surgery in general. The aim of this study is to analyze the surgical seizure outcome of temporal LEAT, focusing on the aspects of surgical strategy. Surgical extent including lesionectomy and extended resection was described in detail. For lateral temporal LEAT, outcome from lesionectomy was comparable to extended resection (χ2 = 0.499, P > 0.1).
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