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Extent of Resection and Residual Tumor Thresholds for Postoperative Total Seizure Freedom in Epileptic Adult Patients Harboring a Supratentorial Diffuse Low-Grade Glioma

Megan Still 1, 2, 3 Alexandre Roux 1, 2, 4 Gilles Huberfeld 5, 6, 7, 8, 9, 10, 11, 12 Luc Bauchet 13, 14 Marie-Hélène Baron 15 Denys Fontaine 16 Marie Blonski 17 Emmanuel Mandonnet 18 Remy Guillevin 19, 20, 21 Jacques Guyotat 22 Luc Taillandier 17 Laurent Capelle 5 Hugues Duffau 13, 14, 23 Johan Pallud 1, 2, 22
Abstract : BACKGROUND: Epileptic seizures impair quality of life in diffuse low-grade glioma (DLGG) patients. Tumor resection significantly impacts postoperative seizure control, but the precise extent of resection (EOR) required for optimal seizure control is not clear yet. OBJECTIVE: To identify the EOR and residual tumor volume that correlated to postoperative seizure control, defined as a total seizure freedom (Class 1A in reference to Engel classification system) with and without antiepileptic drugs in patients undergoing surgical resection of supratentorial DLGG. METHODS: A retrospective review was conducted of all patients who underwent first-line surgical resection of supratentorial DLGG who presented with preoperative seizures without adjuvant oncological treatment. EOR and residual tumor volume were quantified from pre- and post-operative magnetic resonance imagings. Receiver operating characteristic curves were plotted to determine the EOR and residual tumor volume that corresponded to optimal postoperative seizure control. RESULTS: Of the 346 included patients, 65.5% had controlled seizures postoperatively, with higher age at resection (adjusted OR per unit, 1.03 [95% confidence interval:1.01-1.06], P = .043) and higher percentage of resection (adjusted OR per unit, 1.02 [95% confidence interval:1.00-1.03], P < .001) found as independent predictors of postoperative seizure control. Optimal EOR was ≥91% and optimal residual tumor volume was ≤19 cc to improve postoperative seizure control. CONCLUSION: Postoperative seizure control is more likely when EOR is ≥91% and/or when residual tumor volume is ≤19 cc in supratentorial DLGG gliomas who present with seizures. Resected peritumoral cortex should, however, be taken into account in future studies.
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https://hal.umontpellier.fr/hal-02564215
Contributeur : Amandine Michel-Avella <>
Soumis le : mardi 5 mai 2020 - 17:50:21
Dernière modification le : vendredi 15 mai 2020 - 12:22:09

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Megan Still, Alexandre Roux, Gilles Huberfeld, Luc Bauchet, Marie-Hélène Baron, et al.. Extent of Resection and Residual Tumor Thresholds for Postoperative Total Seizure Freedom in Epileptic Adult Patients Harboring a Supratentorial Diffuse Low-Grade Glioma. Neurosurgery, Lippincott, Williams & Wilkins, 2019, 85 (2), pp.E332-E340. ⟨10.1093/neuros/nyy481⟩. ⟨hal-02564215⟩

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