gms | German Medical Science

Objective: To analyze the epileptological and neuro-oncological outcome after epilepsy-surgery in children with refractory seizures caused by brain tumors.

Method: The data of 107 patients (59 male, mean age 12 years, range 1–17) was analyzed. Neuro-oncological follow-up (FU) data was available from 69 patients (65%). Sufficient seizure outcome data (FU >11 months) was available from 102 patients (95%, classified according to ILAE-classification).

Results: Mean FU of all patients was 117 months (1-284 months). Invasive EEG-recording was done in 11% of patients. Tumor localization was mostly temporal (76%). Histologically, 57% were gangliogliomas, 24% gliomas, 14% dysembryoblastic neuroepithelial tumors, 5% Oligodendrogliomas; 77% were classified WHO °I, 19% WHO°II, 4% WHO°III. The rate of permanent unexpected neurological deficits was 3%. Moreover, there was a considerable rate of visual field defects after temporal resections as calculated deficits. Regarding the neuro-oncological FU, 3 patients were treated with adjuvant radio-chemotherapy. One of the three patients had a recurrent astrocytoma (WHO°II) after the initial epilepsy surgery. The other two had a WHO°III tumor and received adjuvant therapy. One patient died from tumor growth (tumor-related mortality 1.5%). At last available outcome, 82% of the patients were seizure-free (ILAE 1). 62% of these were without antiepileptic drugs (AED). Long-term seizure outcome was stable (81% after one year, 79% after 3 years, 85% after 10 years).

Conclusions: Surgical treatment of long-term epilepsy associated tumors in children is safe although calculated postoperative deficits may occur after the resection of the typically temporal localized tumors. Seizure outcome is promising and the majority of seizure-free patients are without AED. The vast majority are benign tumors. However, in some cases malignant tumors and recurrent tumor growth occur and therefore these patients require neuro-oncological follow-up.