Faculty Collaboration Database

Temporal lobe pleomorphic xanthoastrocytoma and chronic epilepsy: long-term surgical outcomes. Clin Neurol Neurosurg 2011 Dec;113(10):918-22

Date

07/12/2011

Pubmed ID

21741164

DOI

10.1016/j.clineuro.2011.06.001

Scopus ID

2-s2.0-81155131173 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

OBJECTIVE: To review clinical features and surgical outcome in patients with temporal lobe pleomorphic xanthoastrocytomas (PXAs) and intractable epilepsy.

METHODS: The Rush Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of a temporal lobe PXA at Rush University Medical Center. Medical records were reviewed for demographic, procedure and follow-up data.

RESULTS: Four patients were identified with a temporal lobe PXA and intractable epilepsy. Average age of seizure onset was 16.5 years and delay to surgery was 90 months. Complex partial seizures were the most common presenting symptom, shown in all 4 patients, and 3 of 4 patients presented with simple partial seizures as well. Seizures occurred with an average frequency of 4 per month (range 1-12 per month). Detailed operative and post-operative follow up data was available for all 4 patients. Gross total resection of the tumor was achieved in all 4 cases. Three of 4 cases had complete resection of the amygdala, and 3 cases had resections of the hippocampus (one partial and two complete). On histopathology, all tumors were found to be low-grade, without mitoses or necrosis. Average follow-up was 120 months (range 29-296 months) with all 4 patients achieving Engel's class I outcome. At last follow up, there was no radiographic or clinical evidence of tumor recurrence. There were no permanent complications.

CONCLUSIONS: Temporal lobe pleomorphic xanthoastrocytomas causing chronic intractable epilepsy occur in younger patients, and demonstrate excellent long-term results in seizure improvement and tumor control with surgery. We support the choice between simple lesionectomy and a tailored resection with amygdalohippocampectomy guided by preoperative findings, intraoperative electrocorticography, and the severity and chronicity of the patient's epilepsy.

Author List

Wallace DJ, Byrne RW, Ruban D, Cochran EJ, Roh D, Whisler WW

Author

Elizabeth J. Cochran MD Adjunct Professor in the Pathology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Amygdala
Astrocytoma
Brain Neoplasms
Electroencephalography
Epilepsy
Epilepsy, Complex Partial
Female
Follow-Up Studies
Hippocampus
Humans
Magnetic Resonance Imaging
Male
Monitoring, Intraoperative
Neuropsychological Tests
Neurosurgical Procedures
Seizures
Surgery, Computer-Assisted
Temporal Lobe
Tomography, X-Ray Computed
Treatment Outcome
Young Adult