Surgical treatment of low grade brain tumors associated with epilepsy in children

Abstract

Objective To explore the strategy of surgical treatment for children with low-grade tumors associated with epilepsy. Methods Clinical data of 30 patients with low grade tumors (ages: 1-14 years) were retrospectively reviewed who underwent surgery from January 2011 to June 2016 at Department of Neurosurgery, Guangdong Sanjiu Brain Hospital. Lesions were located in multiple cerebral lobes in 8 cases, in functional zones in 8 and in non-functional zones in 14 cases (including 10 cases with lesions in the medial temporal lobe). The surgical strategy included subtotal resection, gross-total resection and enlarged resection. Postoperative effects were evaluated by Engel classification. Results A total of 30 patients underwent surgical treatment. Subtotal resection was achieved in 8 cases, gross-total resection in 5 and enlarged resection in 17 (including 9 cases undergoing anterior temporal lobectomy and 1 case of selective amygdalohippocampectomy). The final pathology suggested that there were 11 cases of ganglioglioma, 8 cases of dysembryoplastic neuroepithelial tumor, 2 cases of pilocytic astrocytoma, 3 cases of oligodendroglioma, 3 cases of pleomorphic xanthoastrocytoma, 1 case of diffuse astrocytoma , 1 case of oligoastrocytoma and 1 case of meningioma. The follow-up duration was 1-6 years, with an average of 3.0±1.6 years. For postoperative recover: 28 cases had an outcome of Engel Class I, 1 patient was in Engel Class Ⅱ and 1 patient was in Class Ⅳ. Conclusions For surgical treatment for children with low-grade tumors associated with epilepsy, more attention should be paid to preoperative assessment of the epileptogenic zone. The tumor is not exactly the same as the epileptogenic zone and the strategy of surgical treatment depends on the tumor characteristics as well as whether it is located at temporal lobe or involved in functional areas. Key words: Epilepsy; Child; Brain neoplasms; Low grade; Neurosurgical procedures