Merenzon Martín A, Bhatia Shovan, Levy Adam, Eatz Tiffany, Morell Alexis A, Daggubati Lekhaj C, Luther Evan, Shah Ashish H, Komotar Ricardo J, Ivan Michael E
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Clin Neurol Neurosurg. 2023 Mar;226:107600. doi: 10.1016/j.clineuro.2023.107600. Epub 2023 Jan 18.
Seizures present in 50-90 % of cases with low-grade brain tumors. Frontal lobe epilepsy is associated with dismal seizure outcomes compared to temporal lobe epilepsy. Our objective is to conduct a systematic review, report our case series, and perform a pooled analysis of clinical predictors of seizure outcomes in frontal lobe low-grade brain tumors.
Searches of five electronic databases from January 1990 to June 2022 were reviewed following PRISMA guidelines. Individual patient data was extracted from 22 articles that fit the inclusion criteria. A single-surgeon case series from our institution was also retrospectively reviewed and analyzed through a pooled cohort of 127 surgically treated patients with frontal lobe low-grade brain tumors.
The mean age at surgery was 30.8 years, with 50.4 % of patients diagnosed as oligodendrogliomas. The majority of patients (81.1 %) were seizure-free after surgery (Engel I). On the multivariate analysis, gross total resection (GTR) (OR = 8.77, 95 % CI: 1.99-47.91, p = 0.006) and awake resection (OR = 9.94, 95 % CI: 1.93-87.81, p = 0.015) were associated with seizure-free outcome. A Kaplan-Meier curve showed that the probability of seizure freedom fell to 92.6 % at 3 months, and to 85.5 % at 27.3 months after surgery.
Epilepsy from tumor origin demands a balance between oncological management and epilepsy cure. Our pooled analysis suggests that GTR and awake resections are positive predictive factors for an Engel I at more than 6 months follow-up. To validate these findings, a longer-term follow-up and larger cohorts are needed.
50%-90%的低级别脑肿瘤病例会出现癫痫发作。与颞叶癫痫相比，额叶癫痫的癫痫发作预后较差。我们的目的是进行一项系统综述，报告我们的病例系列，并对额叶低级别脑肿瘤癫痫发作预后的临床预测因素进行汇总分析。
按照PRISMA指南对1990年1月至2022年6月期间五个电子数据库的检索结果进行了审查。从符合纳入标准的22篇文章中提取了个体患者数据。还对我们机构的一个单手术医生病例系列进行了回顾性审查，并通过一个由127例接受手术治疗的额叶低级别脑肿瘤患者组成的汇总队列进行了分析。
手术时的平均年龄为30.8岁，50.4%的患者被诊断为少突胶质细胞瘤。大多数患者（81.1%）术后无癫痫发作（恩格尔I级）。多因素分析显示，全切除（GTR）（OR = 8.77，95%CI：1.99-47.91，p = 0.006）和清醒切除术（OR = 9.94，95%CI：1.93-87.81，p = 0.015）与无癫痫发作的预后相关。Kaplan-Meier曲线显示，术后3个月无癫痫发作的概率降至92.6%，术后27.3个月降至85.5%。
肿瘤源性癫痫需要在肿瘤治疗和癫痫治愈之间取得平衡。我们的汇总分析表明，GTR和清醒切除术是随访6个月以上恩格尔I级的阳性预测因素。为了验证这些发现，需要进行更长时间的随访和更大规模的队列研究。
