Factors associated with preoperative and postoperative epileptic seizure in patients with cerebral ganglioglioma.

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.