Karl Roessler: No financial relationships to disclose
Introduction: Resection strategy in pediatric long-term epilepsy associated tumors (LEATS) consists of pure lesionectomy, ECoG guided tailored resection or even partial/complete lobectomy. To propose an evidence based appropriate surgical strategy, we retrospectively analysed our consecutive institutional series of surgically treated pediatric LEATs.
Methods: Twenty-two children suffering from medically intractable seizures harbouring suspected LEATs were investigated at the pediatric epilepsy monitoring unit using clinical and video EEG monitoring, extended MRI epilepsy protocol and FDG and Methionine (MET) PET examinations. In 17/22 patients ECoG was used for intraoperative pre-and postresection EEG assessment.
Results: All children (mean age 8 yrs, from 2-18) were consecutively resected during a 3 years period. Lesions were located in the temporal lobe in 15 patients and extra-temporally in 7 patients. In temporal LEATS, mainly antero-temporal resections or temporal lobectomies were performed (15 patients), whereas in extratemporal LEATS lesionectomies or tailored resections guided by ECoG (7 patients). Preoperative MRI contrast enhancement was present in 10 GG (45%) and FDG PET hypo-metabolic area in 6 GG (27%). Intensiv MET PET uptake was found in 13 GG, weak MET uptake in 6 GG and no tracer uptake in 1 GG. One DNET showed MET PET uptake, one did not. However, MET PET uptake did not correlate neither with MR contrast uptake intensity, nor with extent of the tumor defined by FLAIR images. In temporal resections, ILAE Class 1 seizure outcome was achieved in 75%, which improved to 94% by performing 6 repeat surgeries with antero-temporal lobectomies. The extratemporal patients experienced ILAE Class 1 seizure outcome in 86% without additional surgeries (mean follow-up 28 month).
Conclusion : As a surgical therapy for extratemporal LEATs a pure lesionectomy or tailored resection may be appropriate. On the contrary, for temporally located LEATs an antero-temporal resection or even temporal lobectomy may be necessary to achieve seizure freedom and avoid recurrences.
