title: Glioneuronal tumors of cerebral hemisphere in children: correlation of surgical resection with seizure outcomes and tumor recurrences.
abstract: OBJECTIVE
  Glioneuronal tumors are common neoplasms among the cerebral hemisphere during childhood. They consist of several histological types, of which gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNTs) are most common and often present with seizures. A great majority of glioneuronal tumors are benign. However, there are conflict reports regarding postoperative tumor recurrence rates and seizure control. The authors analyzed and compared these tumors for their locations and histology and the tumor and seizure control following resection.
  
  
  METHODS
  The authors conducted a retrospective analysis of patients with pediatric glioneuronal tumors in the cerebral hemisphere. All histology reports and neuroimaging are reviewed. Seizure group and non-seizure group were compared with their tumor types and locations. The extent of tumor resections were divided into gross total resection (GTR) and subtotal resection (STR). Postoperative tumor recurrence-free survival (RFS) and seizure-free survival for patients who had the initial surgery done at our institution were calculated using Kaplan-Meier method.
  
  
  RESULTS
  There were 90 glioneuronal tumors including 58 GGs, 22 DNTs, 3 papillary glioneuronal tumor, 3 desmoplastic infantile gangliogliomas, 3 anaplastic GGs, and 1 central neurocytoma. Seventy-one patients (seizure group) presented with seizures. The temporal lobe is the most common location, 50 % in this series. GTR was attained in 79 patients and STR in 11. All of the patients with GTR had lesionectomy, and only six of them had extended corticectomy or partial lobectomy. Postoperative seizure outcome showed that 64 (90 %) of seizure group had Engel's class I, but five patients subsequently developed recurrent seizures. Patients with DNTs had a higher seizure recurrence rate. Tumor RFS was 87 % at 5 years and 75.5 % at 10 years. There are no significant difference in tumor recurrences between GGs and DNTs (p = 0.876). Comparison between GRT (67) and STR (9) showed that in spite of the better 5-year tumor RFSs among GRT group (94 %) than STR group (66 %), the 10-year RFSs showed no significant difference between GRT and STR groups (p = 0.719). Recurrent seizures are often related to recurrent tumor.
  
  
  CONCLUSIONS
  Lesionectomy alone often provides a high-rate seizure freedom. GGs and DNTs are benign tumor, but recurrences of GGs and DNTs are not uncommon. They may show late recurrences in spite of GTR. These patients need longer follow-up for 10 years. Recurrent seizures are often related to a tumor recurrence.
authors.affiliation: Division of Pediatric Neurosurgery, Ann and Robert Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Box 28, Chicago, IL, 60611-2605, USA. ttomita@luriechildrens.org.
authors.forename: Tadanori
authors.initials: T
authors.lastname: Tomita
authors.affiliation: Division of Pediatric Neurosurgery, Ann and Robert Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Box 28, Chicago, IL, 60611-2605, USA.
authors.forename: Jerome M
authors.initials: JM
authors.lastname: Volk
authors.affiliation: Division of Pediatric Neurosurgery, Ann and Robert Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Box 28, Chicago, IL, 60611-2605, USA.|Department of Pediatric Neurosurgery, Children's Hospital of Fudan University, Shanghai, China.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Shen
authors.affiliation: Division of Pediatric Neurosurgery, Ann and Robert Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, Box 28, Chicago, IL, 60611-2605, USA.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Pundy
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018303:Ganglioglioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000209:etiology*; D059906:Neuroimaging; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D012640:Seizures / Q000000981:diagnostic imaging / Q000209:etiology*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Dysembryoplastic neuroepithelial tumor; Epilepsy surgery; Ganglioglioma; Neuroglional tumor; Pediatric brain tumor; Recurrence