The surgical management of pediatric brain tumors causing epilepsy: consideration of the epileptogenic zone.
OBJECTIVE
Children suffering from epilepsy with suspected low-grade tumors may benefit from a surgical approach that considers the epileptogenic zone, which can be more extensive than the tumor region. This study aimed to determine the prevalence of epilepsy in children undergoing supratentorial tumor resection and the factors predictive of postoperative seizure freedom in children with low-grade tumors.


METHODS
Subjects 3 months to 21 years undergoing supratentorial brain tumor resection between 2007 and 2011 were included in this retrospective study. Children with supratentorial, cortically based tumors and a preoperative diagnosis of epilepsy were considered epilepsy surgery candidates. Pre- and postoperative MRI were reviewed and scored for extent of resection, adjacent dysplasia, and remaining abnormal cortex postoperatively.


RESULTS
The prevalence of seizures in all cases of supratentorial tumors was 46/87 (53 %). Eighteen were epilepsy surgery candidates. Eight of 18 (44 %) were seizure-free postoperatively with a mean follow-up of 39 months. Children who were seizure free postoperatively had tried fewer anticonvulsants than those with continued seizures (1.7 v. 2.9, p = 0.01). Presurgical evaluation was nonstandardized, and a more extensive workup and resection were performed in children who continued to have seizures postoperatively.


CONCLUSIONS
All epilepsy surgery candidates had low-grade tumors on histological evaluation, indicating that a surgical approach that takes into consideration the epileptogenic zone is reasonable in this population. Gross total resection should be the goal, with additional attention to resection of the epileptogenic zone when located in the noneloquent cortex.
College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
Bledi
B
Brahimaj
Hansel M
HM
Greiner
James L
JL
Leach
Paul S
PS
Horn
Charles B
CB
Stevenson
Lili
L
Miles
Anna
A
Byars
Katherine
K
Holland
Mary
M
Sutton
Francesco T
FT
Mangano
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000150:complications / Q000601:surgery; D055815:Young Adult