Abstract
The importance of the extent of resection (EOR) has been widely demonstrated as the main predictor for survival, nevertheless its effect on tumor related epilepsy is less investigated. A total of 155 patients were enrolled after a first-line surgery for supratentorial Diffuse Low Grade Gliomas (DLGGs). Postoperative seizure outcome was analyzed stratifying the results by tumor volumetric data and molecular markers according to 2016 WHO classification. Receiver operating characteristic (ROC) curves were computed to asses EOR, residual tumor volume, and ΔT2T1 MRI index (expressing the tumor growing pattern) corresponding to optimal seizure outcome. A total of 70.97% of patients were seizure-free 18 months after surgery. Better seizure outcome was observed in IDH1/2 mutated and 1p/19q codeleted subgroup. At multivariate analysis, age (p = 0.014), EOR (p = 0.030), ΔT2T1 MRI index (p = 0.016) resulted as independent predictors of postoperative seizure control. Optimal parameters to improve postoperative seizure outcome were EOR ≥ 85%, ΔT2T1 MRI index ≤ 18 cm3, residual tumor volume ≤ 15 cm3. This study confirms the role of EOR and tumor growing pattern on postoperative seizure outcome independently from the molecular class. Higher ΔT2T1 MRI index, representing the infiltrative component of the tumor, is associated with worse seizure outcome and strengthens the evidence of common pathogenic mechanisms underlying tumor growth and postoperative seizure outcome.
Highlights
Seizure is the most common onset symptom in patients with supratentorial diffuse low grade gliomas (DLGG), with a seizure frequency ranging from 60% to 90% [1,2]
Demographic, clinical, histological, molecular, and radiological data of the 155 DLGG patients included in the study are summarized in Tables 1 and 2
This study showed the following: (1) 70.97% of epileptic DLGG patients were in Engel Class IA 18 months after surgery; (2) Improved postoperative seizure outcome can be expected for extent of resection (EOR) ≥ 85%, residual tumor ≤
Summary
Seizure is the most common onset symptom in patients with supratentorial diffuse low grade gliomas (DLGG), with a seizure frequency ranging from 60% to 90% [1,2]. Recent studies have pointed out that epileptogenesis and tumor growth in DLGG may share common pathogenic mechanisms that can influence each other, representing two aspects of the same disease [6]. In this context, several genetic alterations have been identified as risk factors of glioma-related epilepsy. These mutations have been associated with metabolic changes that are potentially epileptogenic, in accordance with the capability of IDH-mutated glioma cells to penetrate and surround the neurons in the gray matter [8,9]
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