title: Late recurrence of intractable epilepsy associated with MRI-occult pilocytic astrocytoma in the temporal lobe nine years after initial removal: a case report with surgical and late-seizure recurrence observations.
abstract: A 28-year-old male who presented a relapse of intractable epilepsy consisting of complex partial seizures with occasional secondary generalizations at the age of 26, had undergone removal of a left mesial temporal lobe tumor at another hospital at 18 years old. Pathological examination at that time revealed a low-grade astrocytoma, and the tumor was further treated by complementary adjuvant irradiation therapy. Magnetic resonance imaging (MRI) findings on admission portrayed a post-operative cavity anterior to the atrophied hippocampus on the left side with hyperintense in fluid-attenuated inversion recovery (FLAIR) images. There were no enhanced lesions in T1-weighted gadolinium images. As it was diagnosed as left mesial temporal lobe epilepsy with preoperative evaluations, the patient underwent left anterior temporal lobe resection (TLR). Intraoperative findings revealed that a small lump of grey tissue was attached to the anteromesial side of the sclerotic hippocampus. We surgically removed this and the tissue was a pilocytic astrocytoma. The patient has since remained seizure-free for 2.5 years. Seizure outcomes at postoperative 1-2 years are highly predictive of long-term outcomes after TLR for temporal lobe epilepsy (TLE). Late-seizure recurrence (> postoperative 2 years) with an initially successful outcome rarely occurs in TLR patients. This case report suggests that recurrence of even benign pilocytic astrocytomas may occur when seizure recurs in long-term follow-up.
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734 - 8551, Japan. nishimot@hiroshima-u.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishimoto
authors.forename: Koji
authors.initials: K
authors.lastname: Iida
authors.forename: Kota
authors.initials: K
authors.lastname: Kagawa
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kiura
authors.forename: Akira
authors.initials: A
authors.lastname: Hashizume
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001254:Astrocytoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016371:Cranial Irradiation; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012086:Reoperation; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants