Surgical treatment of low-grade glioma with focal cortical dysplasia in patients with epilepsy_Journal of Epilepsy

Authors：

WU Haiyang ^1,2 ,  ZHANG Xinding ^1,2

1. Department of Neurosurgery, Neurosurgial Laboratory, the Second Hospital of Lanzhou University, Lanzhou 730030, China;
2. Institute of Neurology, Lanzhou University, Lanzhou 730030, China;

Corresponding author：

ZHANG Xinding, Email: zhangxinding@126.com

Keywords：

Multimodal; Low-grade glioma; Epilepsy; Prognosis

DOI：

10.7507/2096-0247.20190046

Video：

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Objective To apply a multimodal preoperative evaluation system to guide the operation of patients with low-grade glioma with focal cortical dysplasia epilepsy.Methods The clinical data of 5 patients with glioma complicated with focal cortical dysplasia who underwent surgical treatment at the Second Hospital of Lanzhou University were collected. The perioperative evaluation was performed using a multimodal evaluation system—multidisciplinary discussion, multi-image combination and multi-method evaluation, so as to improve the total resection rate of epileptic foci and achieve the goal of complete remission. After a follow-up of more than 5 months, the Engel I was defined as a good prognosis and Engel II-IV was defined as a poor prognosis according to the Engel assessment method.Results The postoperative examination of 5 patients showed 4 cases of ganglion cell glioma and 1 case of diffuse astrocytoma, the 5 cases were all found with focal cortical dysplasia. Two of the patients had a small amount of bleeding in the operation area and disappeared at the time of discharge. One lesion was located in the left occipital cortex, one in the upper frontal lobe, two in the temporal lobe and hippocampus, and one in the insula. Five cases of epileptic foci were followed up for 5~16 months without seizures, all graded as Engel I.Conclusions Multimodal assessment system can improve the prognosis of patients with low-grade intracranial tumors with focal cortical dysplasia. In the development of surgical strategies for patients with epilepsy secondary to intracranial tumors, attention should not be paid only to the tumor itself, dysplasia may be associated with tumors, often the underlying cause of epilepsy.

Citation： WU Haiyang, ZHANG Xinding. Surgical treatment of low-grade glioma with focal cortical dysplasia in patients with epilepsy. Journal of Epilepsy, 2019, 5(4): 276-279. doi: 10.7507/2096-0247.20190046 Copy

1.	Kerkhof M, Vecht C J. Seizure characteristics and prognostic factors of gliomas. Epilepsia, 2013, 54(Suppl 9): 12-17.
2.	Prayson RA, Fong J, Najm I. Coexistent pathology in chronic epilepsy patients with neoplasms. Mod Pathol, 2010, 23(8): 1097-1103.
3.	Cossu M, Fuschillo D, Bramerio M, et al. Epilepsy surgery of focal cortical dysplasia-associated tumors. Epilepsia, 2013, 54(Suppl 9): 115-122.
4.	Tassi L, Garbelli R, Colombo N, et al. Type I focal cortical dysplasia: surgical outcome is related to histopathology. Epileptic Disord, 2010, 12(3): 181-191.
5.	Ferrier CH, Aronica E, Leijten FS, et al. Electrocorticographic discharge patterns in glioneuronal tumors and focal cortical dysplasia. Epilepsia, 2006, 47(9): 1477-1486.
6.	Barba C, Coras R, Giordano F, et al. Intrinsic epileptogenicity of gangliogliomas may be independent from co-occurring focal cortical dysplasia. Epilepsy Res, 2011, 97(1-2): 208-213.
7.	Barkovich AJ, Kuzniecky RI, Jackson GD, et al. A developmental and genetic classification for malformations of cortical development. Neurology, 2005, 65(12): 1873-1887.
8.	Blumcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia, 2011, 52(1): 158-174.
9.	Mittal S, Shah AK, Barkmeier DT, et al. Systems biology of human epilepsy applied to patients with brain tumors. Epilepsia, 2013, 54(Suppl 9): 35-39.
10.	You G, Sha Z, Jiang T. The pathogenesis of tumor-related epilepsy and its implications for clinical treatment. Seizure, 2012, 21(3): 153-159.
11.	Compton JJ, Laack NN, Eckel LJ, et al. Long-term outcomes for low-grade intracranial ganglioglioma: 30-year experience from the Mayo Clinic. J Neurosurg, 2012, 117(5): 825-830.
12.	de Groot M, Reijneveld JC, Aronica E, et al. Epilepsy in patients with a brain tumour: focal epilepsy requires focused treatment. Brain, 2012, 135(Pt 4): 1002-1016.
13.	Chang EF, Christie C, Sullivan JE, et al. Seizure control outcomes after resection of dysembryoplastic neuroepithelial tumor in 50 patients. J Neurosurg Pediatr, 2010, 5(1): 123-130.
14.	Japp A, Gielen GH, Becker AJ. Recent aspects of classification and epidemiology of epilepsy-associated tumors. Epilepsia, 2013, 54(Suppl 9): 5-11.
15.	Ruda R, Trevisan E, Soffietti R. Epilepsy and brain tumors. Curr Opin Oncol, 2010, 22(6): 611-620.
16.	Yang L, Morland TB, Schmits K, et al. A prospective study of loss of consciousness in epilepsy using virtual reality driving simulation and other video games. Epilepsy Behav, 2010, 18(3): 238-246.
17.	Cramer JA, Mintzer S, Wheless J, et al. Adverse effects of antiepileptic drugs: a brief overview of important issues. Expert Rev Neurother, 2010, 10(6): 885-891.
18.	Voorhies JM, Cohen-Gadol A. Techniques for placement of grid and strip electrodes for intracranial epilepsy surgery monitoring: pearls and pitfalls. Surg Neurol Int, 2013, 4: 98.
19.	Mittal S, Barkmeier D, Hua J, et al. Intracranial EEG analysis in tumor-related epilepsy: evidence of distant epileptic abnormalities. Clin Neurophysiol, 2016, 127(1): 238-244.
20.	Pallud J, Audureau E, Blonski M, et al. Epileptic seizures in diffuse low-grade gliomas in adults. Brain, 2014, 137(Pt 2): 449-462.
21.	Hauptman JS, Mathern GW. Surgical treatment of epilepsy associated with cortical dysplasia: 2012 update. Epilepsia, 2012, 53(Suppl 4): 98-104.
22.	高曲文, 廖卫平. 局灶性皮质发育不良的最新分类. 实用医学杂志, 2012, 28(13): 2124-2125.
23.	Chang EF, Potts MB, Keles GE, et al. Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg, 2008, 108(2): 227-235.
24.	Buckingham SC, Robel S. Glutamate and tumor-associated epilepsy: glial cell dysfunction in the peritumoral environment. Neurochem Int, 2013, 63(7): 696-701.
25.	Campbell SL, Buckingham SC, Sontheimer H. Human glioma cells induce hyperexcitability in cortical networks. Epilepsia, 2012, 53(8): 1360-1370.
26.	Bonney PA, Boettcher LB, Burks JD, et al. Rates of seizure freedom after surgical resection of diffuse low-grade gliomas. World Neurosurg, 2017, 106: 750-756.
27.	Lerner JT, Salamon N, Hauptman JS, et al. Assessment and surgical outcomes for mild type I and severe type II cortical dysplasia: a critical review and the UCLA experience. Epilepsia, 2009, 50(6): 1310-1335.
28.	Jayakar P, Dunoyer C, Dean P, et al. Epilepsy surgery in patients with normal or non-focal MRI scans: integrative strategies offer long-term seizure relief. Epilepsia, 2008, 49(5): 758-764.
29.	Englot DJ, Raygor KP, Molinaro AM, et al. Factors associated with failed focal neocortical epilepsy surgery. Neurosurgery, 2014, 75(6): 648-645.
30.	Englot DJ, Han SJ, Berger MS, et al. Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors. Neuro Surgery, 2012, 70(4): 921-928.

1. Kerkhof M, Vecht C J. Seizure characteristics and prognostic factors of gliomas. Epilepsia, 2013, 54(Suppl 9): 12-17.
2. Prayson RA, Fong J, Najm I. Coexistent pathology in chronic epilepsy patients with neoplasms. Mod Pathol, 2010, 23(8): 1097-1103.
3. Cossu M, Fuschillo D, Bramerio M, et al. Epilepsy surgery of focal cortical dysplasia-associated tumors. Epilepsia, 2013, 54(Suppl 9): 115-122.
4. Tassi L, Garbelli R, Colombo N, et al. Type I focal cortical dysplasia: surgical outcome is related to histopathology. Epileptic Disord, 2010, 12(3): 181-191.
5. Ferrier CH, Aronica E, Leijten FS, et al. Electrocorticographic discharge patterns in glioneuronal tumors and focal cortical dysplasia. Epilepsia, 2006, 47(9): 1477-1486.
6. Barba C, Coras R, Giordano F, et al. Intrinsic epileptogenicity of gangliogliomas may be independent from co-occurring focal cortical dysplasia. Epilepsy Res, 2011, 97(1-2): 208-213.
7. Barkovich AJ, Kuzniecky RI, Jackson GD, et al. A developmental and genetic classification for malformations of cortical development. Neurology, 2005, 65(12): 1873-1887.
8. Blumcke I, Thom M, Aronica E, et al. The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia, 2011, 52(1): 158-174.
9. Mittal S, Shah AK, Barkmeier DT, et al. Systems biology of human epilepsy applied to patients with brain tumors. Epilepsia, 2013, 54(Suppl 9): 35-39.
10. You G, Sha Z, Jiang T. The pathogenesis of tumor-related epilepsy and its implications for clinical treatment. Seizure, 2012, 21(3): 153-159.
11. Compton JJ, Laack NN, Eckel LJ, et al. Long-term outcomes for low-grade intracranial ganglioglioma: 30-year experience from the Mayo Clinic. J Neurosurg, 2012, 117(5): 825-830.
12. de Groot M, Reijneveld JC, Aronica E, et al. Epilepsy in patients with a brain tumour: focal epilepsy requires focused treatment. Brain, 2012, 135(Pt 4): 1002-1016.
13. Chang EF, Christie C, Sullivan JE, et al. Seizure control outcomes after resection of dysembryoplastic neuroepithelial tumor in 50 patients. J Neurosurg Pediatr, 2010, 5(1): 123-130.
14. Japp A, Gielen GH, Becker AJ. Recent aspects of classification and epidemiology of epilepsy-associated tumors. Epilepsia, 2013, 54(Suppl 9): 5-11.
15. Ruda R, Trevisan E, Soffietti R. Epilepsy and brain tumors. Curr Opin Oncol, 2010, 22(6): 611-620.
16. Yang L, Morland TB, Schmits K, et al. A prospective study of loss of consciousness in epilepsy using virtual reality driving simulation and other video games. Epilepsy Behav, 2010, 18(3): 238-246.
17. Cramer JA, Mintzer S, Wheless J, et al. Adverse effects of antiepileptic drugs: a brief overview of important issues. Expert Rev Neurother, 2010, 10(6): 885-891.
18. Voorhies JM, Cohen-Gadol A. Techniques for placement of grid and strip electrodes for intracranial epilepsy surgery monitoring: pearls and pitfalls. Surg Neurol Int, 2013, 4: 98.
19. Mittal S, Barkmeier D, Hua J, et al. Intracranial EEG analysis in tumor-related epilepsy: evidence of distant epileptic abnormalities. Clin Neurophysiol, 2016, 127(1): 238-244.
20. Pallud J, Audureau E, Blonski M, et al. Epileptic seizures in diffuse low-grade gliomas in adults. Brain, 2014, 137(Pt 2): 449-462.
21. Hauptman JS, Mathern GW. Surgical treatment of epilepsy associated with cortical dysplasia: 2012 update. Epilepsia, 2012, 53(Suppl 4): 98-104.
22. 高曲文, 廖卫平. 局灶性皮质发育不良的最新分类. 实用医学杂志, 2012, 28(13): 2124-2125.
23. Chang EF, Potts MB, Keles GE, et al. Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg, 2008, 108(2): 227-235.
24. Buckingham SC, Robel S. Glutamate and tumor-associated epilepsy: glial cell dysfunction in the peritumoral environment. Neurochem Int, 2013, 63(7): 696-701.
25. Campbell SL, Buckingham SC, Sontheimer H. Human glioma cells induce hyperexcitability in cortical networks. Epilepsia, 2012, 53(8): 1360-1370.
26. Bonney PA, Boettcher LB, Burks JD, et al. Rates of seizure freedom after surgical resection of diffuse low-grade gliomas. World Neurosurg, 2017, 106: 750-756.
27. Lerner JT, Salamon N, Hauptman JS, et al. Assessment and surgical outcomes for mild type I and severe type II cortical dysplasia: a critical review and the UCLA experience. Epilepsia, 2009, 50(6): 1310-1335.
28. Jayakar P, Dunoyer C, Dean P, et al. Epilepsy surgery in patients with normal or non-focal MRI scans: integrative strategies offer long-term seizure relief. Epilepsia, 2008, 49(5): 758-764.
29. Englot DJ, Raygor KP, Molinaro AM, et al. Factors associated with failed focal neocortical epilepsy surgery. Neurosurgery, 2014, 75(6): 648-645.
30. Englot DJ, Han SJ, Berger MS, et al. Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors. Neuro Surgery, 2012, 70(4): 921-928.

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