title: Seizure outcome of surgical treatment of focal epilepsy associated with low-grade tumors in children.
abstract: OBJECTIVE
  Low-grade tumor (LGT) is an increasingly recognized cause of focal epilepsies, particularly in children and young adults, and is frequently associated with cortical dysplasia. The optimal surgical treatment of epileptogenic LGTs in pediatric patients has not been fully established.
  
  
  METHODS
  In the present study, the authors retrospectively reviewed 30 patients (age range 3-18 years) who underwent surgery for histopathologically confirmed LGTs, in which seizures were the only clinical manifestation. The patients were divided into 2 groups according to the type of surgical treatment: patients in Group A (20 cases) underwent only tumor removal (lesionectomy), whereas patients in Group B (11 cases) underwent removal of the tumor and the adjacent epileptogenic zone (tailored surgery). One of the patients, who underwent 2 operations, is included in both groups. Follow-up ranged from 1 to 17 years.
  
  
  RESULTS
  Sixteen (80%) of 20 patients in Group A had an Engel Class I outcome. In this group, 3 of 4 patients who were in Engel Classes II and III had temporomesial lesions. All patients in Group B had temporomesial tumors and were seizure free (Engel Class I). In this series, in temporolateral and extratemporal tumor locations, lesionectomy yielded a good seizure outcome. In addition, a young age at seizure onset (in particular < 4 years) was associated with a poor seizure outcome.
  
  
  CONCLUSIONS
  Tailored resection in temporomesial LGTs was associated with excellent seizure outcome, indicating that an adequate presurgical evaluation including extensive neurophysiological evaluation (long-term videoelectroencephalography monitoring) to plan appropriate surgical strategy is advised.
authors.affiliation: Divisions of Neurosurgery, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy. micol.babini@gmail.com
authors.forename: Micol
authors.initials: M
authors.lastname: Babini
authors.forename: Marco
authors.initials: M
authors.lastname: Giulioni
authors.forename: Ercole
authors.initials: E
authors.lastname: Galassi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Marucci
authors.forename: Matteo
authors.initials: M
authors.lastname: Martinoni
authors.forename: Guido
authors.initials: G
authors.lastname: Rubboli
authors.forename: Lilia
authors.initials: L
authors.lastname: Volpi
authors.forename: Mino
authors.initials: M
authors.lastname: Zucchelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Nicolini
authors.forename: Anna Federica
authors.initials: AF
authors.lastname: Marliani
authors.forename: Roberto
authors.initials: R
authors.lastname: Michelucci
authors.forename: Fabio
authors.initials: F
authors.lastname: Calbucci
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome; D014741:Video Recording