Rácz Attila, Müller Philipp, Becker Albert, Hoffmann Nico, Rüber Theodor, Borger Valeri, Vatter Hartmut, Surges Rainer, Elger Christian E
Department of Epileptology, University Hospital Bonn, Bonn, Germany.
Department of Neuropathology, University Hospital Bonn, Bonn, Germany.
Front Neurol. 2024 May 23;15:1384494. doi: 10.3389/fneur.2024.1384494. eCollection 2024.
Neuroglial tumors are frequently associated with pharmacorefractory epilepsies. However, comprehensive knowledge about long-term outcomes after epilepsy surgery and the main prognostic factors for outcome is still limited. We sought to evaluate long-term outcomes and potential influencing factors in a large cohort of patients who underwent surgery for neuroglial tumors in a single-center setting.
The study analyzed the outcomes of 107 patients who underwent epilepsy surgery for neuroglial tumors between 2001 and 2020 at the Department of Epileptology, University Hospital Bonn, in Germany. The outcomes were evaluated using Engel classification. Differences in outcome related to potential prognostic factors were examined using the Chi2-test, Fisher's exact test and sign test. Additionally, stepwise logistic regression analysis was employed to identify independent prognostic factors.
Complete seizure freedom (Engel Class IA) was achieved in 75% of the operated patients at 12 months, and 56% at the last follow-up visit (70.4 ± 6.2 months, median: 40 months). Completeness of resection was a crucial factor for both 12-month follow-up outcomes and the longest available outcomes, whereas lobar tumor localization, histology (ganglioglioma vs. dysembryoplastic neuroepithelial tumor), history of bilateral tonic-clonic seizures prior to surgery, invasive diagnostics, side of surgery (dominant vs. non-dominant hemisphere), age at epilepsy onset, age at surgery, and epilepsy duration did not consistently impact postsurgical outcomes. Among temporal lobe surgeries, patients who underwent lesionectomy and lesionectomy, including hippocampal resection, demonstrated similar outcomes.
Neuroglial tumors present as excellent surgical substrates in treating structural epilepsy. To achieve an optimal postsurgical outcome, a complete lesion resection should be pursued whenever possible.
神经胶质肿瘤常与药物难治性癫痫相关。然而，关于癫痫手术后的长期预后以及预后的主要预测因素的全面知识仍然有限。我们试图评估在单中心环境下接受神经胶质肿瘤手术的一大群患者的长期预后及潜在影响因素。
本研究分析了2001年至2020年间在德国波恩大学医院癫痫科因神经胶质肿瘤接受癫痫手术的107例患者的预后。使用恩格尔分类法评估预后。使用卡方检验、费舍尔精确检验和符号检验检查与潜在预测因素相关的预后差异。此外，采用逐步逻辑回归分析来确定独立的预测因素。
12个月时，75%的手术患者实现了完全无癫痫发作（恩格尔IA级），在最后一次随访时为56%（70.4±6.2个月，中位数：40个月）。切除的完整性对于12个月的随访结果和最长可获得的结果都是一个关键因素，而肿瘤的叶性定位、组织学类型（神经节细胞胶质瘤与胚胎发育不良性神经上皮肿瘤）、手术前双侧强直阵挛发作史、侵入性诊断、手术侧（优势半球与非优势半球）、癫痫发作起始年龄、手术年龄和癫痫病程并未始终对术后结果产生影响。在颞叶手术中，接受病灶切除术以及包括海马切除术在内的病灶切除术的患者表现出相似的结果。
神经胶质肿瘤是治疗结构性癫痫的理想手术靶点。为了实现最佳的术后结果，应尽可能进行完整的病灶切除。
