Abstract
IntroductionThe postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures.MethodsBetween 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors’ institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2–6).ResultsOverall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4–515.9).ConclusionsATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.
Highlights
The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery
In the case of temporally located glioblastomas, it was previously demonstrated that such supramarginal resection—here in the sense of an anterior temporal lobectomy (ATL) as an epilepsy-surgical therapeutic approach—improves both progression-free and overall survival [9]
Anterior temporal lobectomy (ATL) was performed in 13 patients (39%), whereas the temporal gross-total resections (GTR) was performed in 20 patients (61%)
Summary
The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. We analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures. Results Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. Conclusions ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma. In the case of temporally located glioblastomas, it was previously demonstrated that such supramarginal resection—here in the sense of an anterior temporal lobectomy (ATL) as an epilepsy-surgical therapeutic approach—improves both progression-free and overall survival [9]. Due to the scarcity of data, it remains uncertain to what extent this therapeutic approach has an impact on tumor-related epilepsy (TRE)
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