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Epilepsy Surgery for Glioneuronal Tumors in Childhood: Avoid Loss of Time

Ramantani, Georgia MD*; Kadish, Navah Ester PhD; Anastasopoulos, Constantin MD§,¶; Brandt, Armin Dipl Biol*; Wagner, Kathrin PhD*; Strobl, Karl MD; Mayer, Hans PhD; Schubert-Bast, Susanne MD; Stathi, Angeliki MD*; Korinthenberg, Rudolf MD§; Feuerstein, Thomas J. MD#; Mader, Irina MD; van Velthoven, Vera MD#; Zentner, Josef MD#; Schulze-Bonhage, Andreas MD*; Bast, Thomas MD‡,‖

doi: 10.1227/NEU.0000000000000327
Research-Human-Clinical Studies

BACKGROUND: In contrast to the abundance of seizure outcome reports in epilepsy surgery for glioneuronal tumors in childhood and adolescence, there is a dearth of information regarding cognitive outcomes.

OBJECTIVE: To investigate the seizure and cognitive outcome of children and adolescents that underwent resective surgery for glioneuronal tumor-associated refractory epilepsy and determine their predictive factors.

METHODS: We retrospectively analyzed the presurgical findings, resection types, and outcomes over 1.3 to 12.3 years (mean, 7.3) of 29 consecutive patients, who underwent resection in 2000 to 2011. The mean age at epilepsy onset was 7.9 years (range, 0-15.4), the mean age at surgery was 11.7 years (range, 2.6-17.3), and the mean epilepsy duration to surgery was 3.8 years (range, 0.3-15.3). Etiology comprised 13 dysembryoplastic neuroepithelial tumors and 16 gangliogliomas, with additional focal cortical dysplasia in 5 cases.

RESULTS: Eighty-six percent of children were seizure free 12 months after surgery; at final follow-up, 76% remained seizure free and 62% had discontinued antiepileptic drugs. Gross total resection was related to significantly higher rates of seizure freedom. Higher presurgical cognitive functioning (full-scale IQ, verbal IQ) was related to shorter epilepsy duration to surgery independent of age at epilepsy onset, thus determining postsurgical functioning. Improvements in verbal IQ, performance IQ, and visual memory as well as a trend toward improvement in full-scale IQ were established after surgery. Despite individual losses in full-scale IQ, verbal or visual memory, no deterioration was noted in any cognitive variable on a group level.

CONCLUSION: Completeness of resection predisposes to favorable outcomes regarding seizure alleviation. Whereas cognitive functioning deteriorates with time in glioneuronal tumor-related refractory epilepsy, surgery is linked to improvement rather than to deterioration on a group level.

ABBREVIATIONS: AED, antiepileptic drugs

DNET, dysembryoplastic neuroepithelial tumor

ECoG, electrocorticography

EEG, electroencephalography

FCD, focal cortical dysplasia

FSIQ, full-scale IQ

MTS, mesial temporal structures

PIQ, performance IQ

SD, standard deviation

VIQ, verbal IQ

*Epilepsy Centre, University Hospital Freiburg, Freiburg, Germany;

Department of General Pediatrics, Children's University Hospital, Heidelberg, Germany;

§Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany;

Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany;

Epilepsy Centre Kork, Kehl-Kork, Germany;

#Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany

Correspondence: Georgia Ramantani, MD, Epilepsy Centre, University Hospital Freiburg, Breisacher St 64, 79106 Freiburg, Germany. E-mail:

Received August 30, 2013

Accepted February 07, 2014

Copyright © by the Congress of Neurological Surgeons