title: Epilepsy surgery for glioneuronal tumors in childhood: avoid loss of time.
abstract: BACKGROUND
  In contrast to the abundance of seizure outcome reports in epilepsy surgery for glioneuronal tumors in childhood and adolescence, there is a dearth of information regarding cognitive outcomes.
  
  
  OBJECTIVE
  To investigate the seizure and cognitive outcome of children and adolescents that underwent resective surgery for glioneuronal tumor-associated refractory epilepsy and determine their predictive factors.
  
  
  METHODS
  We retrospectively analyzed the presurgical findings, resection types, and outcomes over 1.3 to 12.3 years (mean, 7.3) of 29 consecutive patients, who underwent resection in 2000 to 2011. The mean age at epilepsy onset was 7.9 years (range, 0-15.4), the mean age at surgery was 11.7 years (range, 2.6-17.3), and the mean epilepsy duration to surgery was 3.8 years (range, 0.3-15.3). Etiology comprised 13 dysembryoplastic neuroepithelial tumors and 16 gangliogliomas, with additional focal cortical dysplasia in 5 cases.
  
  
  RESULTS
  Eighty-six percent of children were seizure free 12 months after surgery; at final follow-up, 76% remained seizure free and 62% had discontinued antiepileptic drugs. Gross total resection was related to significantly higher rates of seizure freedom. Higher presurgical cognitive functioning (full-scale IQ, verbal IQ) was related to shorter epilepsy duration to surgery independent of age at epilepsy onset, thus determining postsurgical functioning. Improvements in verbal IQ, performance IQ, and visual memory as well as a trend toward improvement in full-scale IQ were established after surgery. Despite individual losses in full-scale IQ, verbal or visual memory, no deterioration was noted in any cognitive variable on a group level.
  
  
  CONCLUSIONS
  Completeness of resection predisposes to favorable outcomes regarding seizure alleviation. Whereas cognitive functioning deteriorates with time in glioneuronal tumor-related refractory epilepsy, surgery is linked to improvement rather than to deterioration on a group level.
authors.affiliation: *Epilepsy Centre, University Hospital Freiburg, Freiburg, Germany; ‡Department of General Pediatrics, Children's University Hospital, Heidelberg, Germany; §Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany; ¶Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany; ‖Epilepsy Centre Kork, Kehl-Kork, Germany; #Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Georgia
authors.initials: G
authors.lastname: Ramantani
authors.forename: Navah Ester
authors.initials: NE
authors.lastname: Kadish
authors.forename: Constantin
authors.initials: C
authors.lastname: Anastasopoulos
authors.forename: Armin
authors.initials: A
authors.lastname: Brandt
authors.forename: Kathrin
authors.initials: K
authors.lastname: Wagner
authors.forename: Karl
authors.initials: K
authors.lastname: Strobl
authors.forename: Hans
authors.initials: H
authors.lastname: Mayer
authors.forename: Susanne
authors.initials: S
authors.lastname: Schubert-Bast
authors.forename: Angeliki
authors.initials: A
authors.lastname: Stathi
authors.forename: Rudolf
authors.initials: R
authors.lastname: Korinthenberg
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Feuerstein
authors.forename: Irina
authors.initials: I
authors.lastname: Mader
authors.forename: Vera
authors.initials: V
authors.lastname: van Velthoven
authors.forename: Josef
authors.initials: J
authors.lastname: Zentner
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
authors.forename: Thomas
authors.initials: T
authors.lastname: Bast
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000209:etiology / Q000601:surgery*; D005260:Female; D018303:Ganglioglioma / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome