Surgical strategy and seizure outcome in dysembryoplastic neuroepithelial tumor

Abstract

Objective Dysembryoplastic neuroepithelial tumor (DNET) is a rare intracranial tumor with drug-resistant epilepsy.The authors present a review of 18 patients who underwent surgical removal of a DNET to discuss the surgical strategy epilepsy outcome.Methods There are 18 DNET patients from Aprial 2004 to Aprial 2010,4 patients were lost to follow up.Medical records,neuroradiological images of all 14 patients were investigated.There were 10 male and 4 female patients.Age of patients ranged from 4 to 25 years,mean 10.3.We preferred lesionectomy and intraoperative electrocorticography concomitantly.After tumor removal,we would coagulate surrounding cortex with bipolar if there were still spikes or sharp waves on electrocorticography.Engel prognosis was recorded for every patient.Results Time of follow-up ranged from 24 to 96 months,mean 46.6 months.Tumor was removed totally in 12 cases,partially in 2 cases.Intraoperative ultrasound was used in five patients and found tumor omission in 1 among the 5 patients.Engel prognosis was Ⅰ grade in 12 patients whose tumor was removed totally,and complete antiepileptic drugs withdrawn was achieved in 11 out of 12 patients.The other two patients got Engel Ⅱ and Ⅳ prognosis respectively.Tumor residue didn't regrow in a follow-up time of 54,63 months respectively.Conclusion Lesionectomy and bipolar coagulation are effective for seizure control.Residual tumor is a significant risk factor for poor seizure outcome.Intraoperative ultrasound are recommended to make sure total removal.Electrocorticography should be routinely used before and after tumor removal for a better seizure outcome. Key words: Dysembryoplastic neuroepithelial tumor; Operation; Epilepsy