Article
Association of neuroepithelial tumours and microscopic focal cortical dysplasias in patients with drug-resistant temporal lobe epilepsy.
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Published: | September 11, 2012 |
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Background and Purpose: There is controversy between the extension of the surgical resection of electrophysiologically monitored brain tumors and the postoperative clinical evolution of patients with pharmacoresistant temporal lobe epilepsy (TLE). The aim of this study was evaluate the histopathological spectrum and the electroclinical and imagenologic characteristics, as well as the clinical evolution in patients with neuroepithelial tumors included in the program of epilepsy surgery at CIREN.
Patients and methods: Cases with tumors and pharmacoresistant epilepsy operated from 2002–2009 were selected from the database. The patients underwent temporal lobectomy adjusted by electrocorticography (ECoG). The histopathological pattern, ictal video-EEG and intraoperative EcoG are described here.
Results: Of the 25 analyzed patients, 5 presented MRI neocortical structural lesions. One of them was an arachnoid cyst, a reason for its exclusion from the study. The histopathologic exam evidenced one patient with pilocytic astrocytoma, two with ganglioglioma (GG) and one with dysembryoplastic neuroepithelial tumour (DNT); the last three associated to a focal cortical dysplasia (FCD) type IA (2 cases) and IB (I case) according to Palmini classification. These cases were reclassified as FCD IIIb using the proposal classification of Blümcke et al. All cases were seizure free until the last clinical evaluation.
Conclusions: The association of glioneuronal tumors was evidenced (GG and DNT) with microscopic FCD in TLE patients. The temporal lobectomy adjusted by ECoG allowed achieving the condition of seizure free in patients with TLE and tumors of the neuroepithelial tissue, even in cases associated to FCD.