Yu-Chi Wang1,2,3, Cheng-Chi Lee1, Hirokazu Takami4, Stephanie Shen5, Ko-Ting Chen1,2, Kuo-Chen Wei1, Min-Hsien Wu2, Gregory Worrell3, Pin-Yuan Chen6,7,8. 1. Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan. 2. PhD. Program of Biomedical Engineering and Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan. 3. Department of Neurology, Mayo Clinic, Rochester, MN, USA. 4. Division of Neurosurgery, University of Toronto, Toronto, Canada. 5. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA. 6. Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan. pinyuanc@gmail.com. 7. Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, and School of medicine, Chang Gung University, Taoyuan, Taiwan. pinyuanc@gmail.com. 8. Community Medicine Research Center and Laboratory Animal Center, Chang Gung Memorial Hospital, Keelung, Taiwan. pinyuanc@gmail.com.
Abstract
PURPOSE: Awake craniotomy is well-established for tumors resected in eloquent brain areas. Whether awake craniotomy provides improved seizure control in patients with epileptic gliomas has not been well evaluated. This study analyzed the incidence, risk factors and outcome of seizures during and following awake craniotomies for patients presenting with epilepsy and glioma. METHODS: Forty-one patients undergoing awake craniotomies for epileptic gliomas were retrospectively analyzed. Postoperative seizure was defined as either early (postoperative day 7 + before) or late onset (after postoperative day 7). Neurologic function was assessed with modified Rankin Scales (mRS) and seizure outcome was assessed using International League Against Epilepsy (ILAE) classification. Multivariable logistic regression was used for clinical variables associated with postoperative seizures. RESULTS: Three patients (7.3%) had intraoperative seizures however did not fail the awake craniotomies. Mean mRS before and after the awake craniotomies were 2.4 and 2.1, respectively (P = 0.032). Fourteen (34.1%) patients had early seizures, which caused longer hospitalization than those without early seizures (P = 0.03). Surgical resection to isocitrate dehydrogenase 1 (IDH1) mutation tumors, comparing to IDH1 wild type tumors, caused better postoperative seizure control. 6-month late seizure freedom was achieved in 33 patients (80.5%). Early seizure recurrence (odds ratio = 30.75; P = 0.039) and postoperative mRS ≥ 3 (odds ratio = 7.00; P = 0.047) were independent risk factors for late seizures. CONCLUSIONS: Intraoperative seizures could be well-controlled during awake craniotomies. Early postoperative seizures extended hospitalization and strongly predicted late seizure recurrence. Awake craniotomies benefited long-term seizure control in patients with epileptic gliomas.
PURPOSE: Awake craniotomy is well-established for tumors resected in eloquent brain areas. Whether awake craniotomy provides improved seizure control in patients with epilepticgliomas has not been well evaluated. This study analyzed the incidence, risk factors and outcome of seizures during and following awake craniotomies for patients presenting with epilepsy and glioma. METHODS: Forty-one patients undergoing awake craniotomies for epilepticgliomas were retrospectively analyzed. Postoperative seizure was defined as either early (postoperative day 7 + before) or late onset (after postoperative day 7). Neurologic function was assessed with modified Rankin Scales (mRS) and seizure outcome was assessed using International League Against Epilepsy (ILAE) classification. Multivariable logistic regression was used for clinical variables associated with postoperative seizures. RESULTS: Three patients (7.3%) had intraoperative seizures however did not fail the awake craniotomies. Mean mRS before and after the awake craniotomies were 2.4 and 2.1, respectively (P = 0.032). Fourteen (34.1%) patients had early seizures, which caused longer hospitalization than those without early seizures (P = 0.03). Surgical resection to isocitrate dehydrogenase 1 (IDH1) mutation tumors, comparing to IDH1 wild type tumors, caused better postoperative seizure control. 6-month late seizure freedom was achieved in 33 patients (80.5%). Early seizure recurrence (odds ratio = 30.75; P = 0.039) and postoperative mRS ≥ 3 (odds ratio = 7.00; P = 0.047) were independent risk factors for late seizures. CONCLUSIONS:Intraoperative seizures could be well-controlled during awake craniotomies. Early postoperative seizures extended hospitalization and strongly predicted late seizure recurrence. Awake craniotomies benefited long-term seizure control in patients with epilepticgliomas.
Authors: Giannantonio Spena; Elena Roca; Francesco Guerrini; Pier Paolo Panciani; Lorenzo Stanzani; Andrea Salmaggi; Sabino Luzzi; Marco Fontanella Journal: J Neurooncol Date: 2019-09-24 Impact factor: 4.130
Authors: Elena Roca; Johan Pallud; Francesco Guerrini; Pier Paolo Panciani; Marco Fontanella; Giannantonio Spena Journal: Neurosurg Rev Date: 2019-12-03 Impact factor: 3.042
Authors: Morgane Casanova; Anne Clavreul; Gwénaëlle Soulard; Matthieu Delion; Ghislaine Aubin; Aram Ter Minassian; Renaud Seguier; Philippe Menei Journal: J Med Internet Res Date: 2021-03-24 Impact factor: 5.428