title: Temporal lobe pleomorphic xanthoastrocytoma and chronic epilepsy: long-term surgical outcomes.
abstract: OBJECTIVE
  To review clinical features and surgical outcome in patients with temporal lobe pleomorphic xanthoastrocytomas (PXAs) and intractable epilepsy.
  
  
  METHODS
  The Rush Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of a temporal lobe PXA at Rush University Medical Center. Medical records were reviewed for demographic, procedure and follow-up data.
  
  
  RESULTS
  Four patients were identified with a temporal lobe PXA and intractable epilepsy. Average age of seizure onset was 16.5 years and delay to surgery was 90 months. Complex partial seizures were the most common presenting symptom, shown in all 4 patients, and 3 of 4 patients presented with simple partial seizures as well. Seizures occurred with an average frequency of 4 per month (range 1-12 per month). Detailed operative and post-operative follow up data was available for all 4 patients. Gross total resection of the tumor was achieved in all 4 cases. Three of 4 cases had complete resection of the amygdala, and 3 cases had resections of the hippocampus (one partial and two complete). On histopathology, all tumors were found to be low-grade, without mitoses or necrosis. Average follow-up was 120 months (range 29-296 months) with all 4 patients achieving Engel's class I outcome. At last follow up, there was no radiographic or clinical evidence of tumor recurrence. There were no permanent complications.
  
  
  CONCLUSIONS
  Temporal lobe pleomorphic xanthoastrocytomas causing chronic intractable epilepsy occur in younger patients, and demonstrate excellent long-term results in seizure improvement and tumor control with surgery. We support the choice between simple lesionectomy and a tailored resection with amygdalohippocampectomy guided by preoperative findings, intraoperative electrocorticography, and the severity and chronicity of the patient's epilepsy.
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA. David Wallace@rush.edu
authors: David J
authors: DJ
authors: Wallace
authors: Richard W
authors: RW
authors: Byrne
authors: Dmitry
authors: D
authors: Ruban
authors: Elizabeth J
authors: EJ
authors: Cochran
authors: David
authors: D
authors: Roh
authors: Walt W
authors: WW
authors: Whisler
mesh_terms: D000293:Adolescent; D000679:Amygdala / Q000601:surgery; D001254:Astrocytoma / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D004569:Electroencephalography; D004827:Epilepsy / Q000209:etiology* / Q000601:surgery; D017029:Epilepsy, Complex Partial / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016343:Monitoring, Intraoperative; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000379:methods*; D012640:Seizures / Q000209:etiology; D025321:Surgery, Computer-Assisted; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult