Long-Term Surgical Outcomes of Temporal Lobe Epilepsy Associated With Low-Grade Brain Tumors

초록

BACKGROUND: Tumor-related temporal lobe epilepsy (TLE) has a high likelihood of medical intractability and requires surgical treatment. The aims of this study were to analyze the long-term surgical outcomes of and to present appropriate surgical strategies for tumor-related TLE. METHODS: The clinical data of 87 consecutive patients diagnosed with tumor-related TLE were analyzed. The median age at surgery was 22 years. Sixteen patients had a tumor confined to the amygdala or the parahippocampal gyrus, and 10 of them received a tailored lesionectomy without hippocampectomy. The surgical outcome was evaluated based on 3 aspects: seizure control, tumor control, and discontinuation of antiepileptic drugs (AEDs). RESULTS: The actuarial seizure and tumor control rates at the fifth year postoperatively were 79% and 90%, respectively. Seizure control was highly correlated with tumor control. The following factors were found to be significantly associated with poor seizure control: duration of epilepsy >10 years, presence of a remote focus on surface electroencephalography, and incomplete tumor removal. The actuarial AED maintenance rates were 47% at the second year and 11% at the fifth year. The median time to AED discontinuation was 22 months. A younger age at surgery was found to be significantly associated with an increased chance of AED discontinuation. Tailored resection focusing on the tumor resulted in a favorable outcome, even for tumors confined to the amygdala or the parahippocampal gyrus. CONCLUSIONS: Surgical treatment of tumor-related TLE resulted in long-term seizure control in the majority of patients. Maximal tumor removal can be recommended for tumor-related TLE. Cancer 2009;115:5771-9. (C) 2009 American Cancer Society.

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