Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA.
Epilepsia. 2012 Jan;53(1):51-7. doi: 10.1111/j.1528-1167.2011.03269.x. Epub 2011 Sep 20.
Gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNETs) are low-grade brain tumors of glioneuronal origin that commonly present with seizures. Achieving seizure control in patients with glioneuronal tumors remains underappreciated, as tumor-related epilepsy significantly affects patients' quality-of-life.
We performed a quantitative and comprehensive systematic literature review of seizure outcomes after surgical resection of GGs and DNETs associated with seizures. We evaluated 910 patients from 39 studies, and stratified outcomes according to several potential prognostic variables.
Overall, 80% of patients were seizure-free after surgery (Engel class I), whereas 20% continued to have seizures (Engel class II-IV). We observed significantly higher rates of seizure-freedom in patients with ≤1 year duration of epilepsy compared to those with >1 year of seizures [odds ratio (OR) 9.48; 95% confidence interval (CI) 2.26-39.66], and with gross-total resection over subtotal lesionectomy (OR 5.34; 95% CI 3.61-7.89). In addition, the presence of secondarily generalized seizures preoperatively predicted a lower rate of seizure-freedom after surgery (OR 0.40; 95% CI 0.24-0.66). Outcomes did not differ significantly between adults and children, patients with temporal lobe versus extratemporal tumors, pathologic diagnosis of GG versus DNET, medically controlled versus refractory seizures, or with the use of electrocorticography (ECoG). Extended resection of temporal lobe tumors, with hippocampectomy and/or corticectomy, conferred additional benefit.
These results suggest that early operative intervention and gross-total resection are critically important factors in achieving seizure-freedom, and thus improving quality-of-life, in patients with glioneuronal tumors causing epilepsy.
神经节神经胶质瘤（GGs）和发育不良性神经上皮肿瘤（DNETs）是起源于胶质神经元的低级别脑肿瘤，通常表现为癫痫发作。由于肿瘤相关性癫痫显著影响患者的生活质量，因此，对于胶质神经元肿瘤患者，实现癫痫控制仍未得到充分重视。
我们对与癫痫相关的 GGs 和 DNET 切除术后的癫痫发作转归进行了定量和全面的系统文献回顾。我们评估了 39 项研究中的 910 例患者，并根据几种潜在的预后变量对结果进行了分层。
总体而言，80%的患者手术后无癫痫发作（Engel 分级 I），而 20%的患者仍有癫痫发作（Engel 分级 II-IV）。与癫痫发作时间＞1 年的患者相比，癫痫发作时间≤1 年的患者无癫痫发作的比例显著更高[比值比（OR）9.48；95%置信区间（CI）2.26-39.66]，且行大体全切除的患者比例高于行次全切除的患者（OR 5.34；95% CI 3.61-7.89）。此外，术前存在继发性全身性癫痫发作预示着手术后无癫痫发作的比例较低（OR 0.40；95% CI 0.24-0.66）。成人与儿童、颞叶与非颞叶肿瘤、GG 与 DNET 的病理诊断、药物控制与难治性癫痫、是否使用皮层脑电图（ECoG）之间的预后均无显著差异。颞叶肿瘤的扩大切除，包括海马切除术和/或皮质切除术，可带来额外获益。
这些结果表明，早期手术干预和大体全切除是实现癫痫无发作和提高胶质神经元肿瘤致痫患者生活质量的关键因素。
