title: Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors.
abstract: BACKGROUND
  Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life.
  
  
  OBJECTIVE
  To assess how the extent of temporal lobe resection influences seizure outcome.
  
  
  METHODS
  We performed a quantitative, comprehensive systematic literature review of seizure control outcomes in 1181 patients with epilepsy across 41 studies after surgical resection of low-grade temporal lobe gliomas and glioneuronal tumors. We measured seizure-freedom rates after subtotal resection vs gross-total lesionectomy alone vs tailored resection, including gross-total lesionectomy with hippocampectomy and/or anterior temporal lobe corticectomy.
  
  
  RESULTS
  Included studies were observational case series, and no randomized, controlled trials were identified. Although only 43% of patients were seizure-free after subtotal tumor resection, 79% of individuals were seizure-free after gross-total lesionectomy (OR = 5.00, 95% confidence interval [CI]: 3.33-7.14). Furthermore, tailored resection with hippocampectomy plus corticectomy conferred additional benefit over gross-total lesionectomy alone, with 87% of patients achieving seizure freedom (OR = 1.82, 95% CI: 1.23-2.70). Overall, extended resection with hippocampectomy and/or corticectomy over gross-total lesionectomy alone significantly predicted seizure freedom (OR = 1.18, 95% CI: 1.11-1.26). Age <18 years and mesial temporal location also prognosticated favorable seizure outcome.
  
  
  CONCLUSIONS
  Gross-total lesionectomy of low-grade temporal lobe tumors results in significantly improved seizure control over subtotal resection. Additional tailored resection including the hippocampus and/or adjacent cortex may further improve seizure control, suggesting dual pathology may sometimes allow continued seizures after lesional excision.
authors: Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA.
authors: Dario J
authors: DJ
authors: Englot
authors: Seunggu J
authors: SJ
authors: Han
authors: Mitchel S
authors: MS
authors: Berger
authors: Nicholas M
authors: NM
authors: Barbaro
authors: Edward F
authors: EF
authors: Chang
mesh_terms: D001932:Brain Neoplasms / Q000150:complications* / Q000601:surgery*; D005910:Glioma / Q000150:complications* / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D012640:Seizures / Q000209:etiology* / Q000601:surgery; D013702:Temporal Lobe