Systematic Review of Seizure Outcomes After Lesionectomy and Epilepsy Surgery in Adults with Low-grade Glioma and Epilepsy
Abstract number :
2.275
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2204863
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Kapil Gururangan, MD – Ronald Reagan UCLA Medical Center; Shatabdi Joshi, MPH, MS – Neurology – Icahn School of Medicine at Mount Sinai; Leah Blank, MD, MPH – Neurology – Icahn School of Medicine at Mount Sinai; Churl-Su Kwon, MBBS, MPH – Neurology – Icahn School of Medicine at Mount Sinai; Samantha Walsh, MLS, MA – Levy Library – Icahn School of Medicine at Mount Sinai; Rebecca Brown, MD, PhD – Neurology – Icahn School of Medicine at Mount Sinai; Fedor Panov, MD – Neurosurgery – Icahn School of Medicine at Mount Sinai; Constantinos Hadjipanayis, MD, PhD – Neurosurgery – Icahn School of Medicine at Mount Sinai; Nathalie Jetté, MD, MSc – Neurology – Icahn School of Medicine at Mount Sinai
Rationale: Epilepsy is a common presentation of brain tumors, especially low-grade gliomas (LGG). While gross-total resection may help decrease seizure frequency, whether initial surgical management should also consider broader resection of the epileptogenic zone (EZ) to maximize seizure control remains an open question. Our aim was to examine seizure outcome following lesionectomy and epilepsy surgery in adults with LGG and brain tumor-related epilepsy (BTRE).
Methods: The systematic review, part of a broader review of seizure outcomes following neurosurgical interventions for primary and metastatic supratentorial brain tumors, was registered with PROSPERO (CRD42021262976) and followed PRISMA standards. Embase, Medline, and Cochrane databases were searched from 1985 to 2022. Studies of adults (sample size ≥ 10) with BTRE due to LGG who underwent lesionectomy or tailored epilepsy surgery (supratotal resection, sometimes guided by pre-/intra-operative electrophysiology, aimed at maximal EZ removal) that reported post-operative seizure outcomes beyond 30 days were included. We compared rates of favorable seizure outcome (Engel class 1-2) between lesionectomy and epilepsy surgery, epilepsy surgery with and without intra-operative EZ delineation, and common tumor pathologies.
Results: We identified 42 eligible studies describing 1820 patients with LGG and BTRE who underwent surgery. The most common pathologies were unspecified LGG (n=824), astrocytoma (n=369), oligodendroglioma (n=296), and glioneuronal tumors (n=222). Fifteen studies included lesionectomy only, 14 epilepsy surgery only (10 with intraoperative EZ delineation and 4 without), and 13 both lesionectomy and epilepsy surgery. More patients had a favorable seizure outcome after epilepsy surgery (318/395, 80.5%) then after lesionectomy (968/1425, 67.9%). Seizure outcome was similar in those who had surgery with intraoperative EZ delineation (188/238, 79.0%) compared to epilepsy surgery without this data (130/157, 82.8%). The use of intraoperative electrophysiology did not always result in maximal resection of the identified EZ. The greatest differences in favorable seizure outcomes between epilepsy surgery and lesionectomy were seen for glioneuronal tumors (92/108 [85.2%] vs. 40/77 [51.9%]). Risk of bias, study quality assessment, and meta-analyses (where appropriate) will also be presented.
Conclusions: Surgical resections tailored to maximize EZ resection, whether or not they were guided by intraoperative electrophysiology, may be associated with higher rates of favorable seizure outcome in patients with LGG and BTRE compared to surgical resections solely directed at tumor excision. The optimal surgical management of BTRE might benefit from increased consideration of EZ delineation and resection to maximize seizure outcomes.
Funding: KG was supported by grant funding from the NINDS (R25NS079102) and the Leon Levy Foundation.
Surgery