Factors associated with seizure freedom in the surgical resection of glioneuronal tumors
Factors associated with seizure freedom in the surgical resection of glioneuronal tumors
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DOI：
10.1111/j.1528-1167.2011.03269.x
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发表时间：
2012-01-01
期刊：
影响因子：
5.6
通讯作者：
Chang, Edward F.
中科院分区：
文献类型：
--
作者：
Englot, Dario J.;Berger, Mitchel S.;Chang, Edward F.
目的：神经节胶质瘤（GG）和胚胎发育不良神经上皮肿瘤（DNET）是胶质神经元起源的低级别脑肿瘤，通常伴有癫痫发作。由于肿瘤相关癫痫显着影响患者的生活质量，实现胶质神经肿瘤患者癫痫发作的控制仍然未被充分认识。方法：我们对手术切除与癫痫发作相关的 GG 和 DNET 后的癫痫发作结果进行了定量和全面的系统文献综述。我们评估了 39 项研究中的 910 名患者，并根据几个潜在的预后变量对结果进行分层。主要发现：总体而言，80% 的患者术后无癫痫发作（Engel I 级），而 20% 的患者继续癫痫发作（Engel II-IV 级）。我们观察到，与癫痫发作 > 1 年的患者相比，癫痫病程 1 年以上的患者无癫痫发作的比率显着较高 [比值比 (OR) 9.48； 95% 置信区间 (CI) 2.26-39.66]，以及大体全切除优于病灶次全切除（OR 5.34；95% CI 3.61-7.89）。此外，术前出现继发性全身性癫痫发作预示术后无癫痫发作的比例较低（OR 0.40；95% CI 0.24-0.66）。成人和儿童、颞叶肿瘤患者与颞叶外肿瘤患者、GG 病理诊断与 DNET、医学控制性癫痫发作与难治性癫痫发作或使用皮质电图 (ECoG) 之间的结果没有显着差异。颞叶肿瘤的扩大切除，结合海马切除术和/或皮质切除术，可带来额外的益处。 意义：这些结果表明，早期手术干预和大体全切除对于导致癫痫的胶质神经元肿瘤患者实现无癫痫发作至关重要，从而提高生活质量。
Purpose: 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.Methods: 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.Key Findings: 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 mu 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.Significance: 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.