ObjectiveTo summarize the surgical experiences of low-grade glioma on functional areas. MethodsFifty-four patients with low-grade glioma on functional areas were treated in our department from December 2009 to December 2012. We retrospectively analyzed their clinical data. ResultsThirty-six cases were located preoperatively by diffusion tensor imaging, 13 patients underwent intraoperative B ultrasound tumor localization, and 5 underwent intraoperative wake-up anesthesia. Total resection of tumors was performed on 42 patients, subtotal resection on 10, and partial resection on 2, and no patient died during the operation. The follow-up ranged from 6 to 24 months averaging 12. There was no significant difference in Karnofsky performance scale before and after surgery (P>0.05). ConclusionThe comprehensive application of various localization methods can protect function to the best advantage and resect tumor to the largest degree, and thus improves patients' quality of life.
ObjectiveTo apply a multimodal preoperative evaluation system to guide the operation of patients with low-grade glioma with focal cortical dysplasia epilepsy.MethodsThe clinical data of 5 patients with glioma complicated with focal cortical dysplasia who underwent surgical treatment at the Second Hospital of Lanzhou University were collected. The perioperative evaluation was performed using a multimodal evaluation system—multidisciplinary discussion, multi-image combination and multi-method evaluation, so as to improve the total resection rate of epileptic foci and achieve the goal of complete remission. After a follow-up of more than 5 months, the Engel I was defined as a good prognosis and Engel II-IV was defined as a poor prognosis according to the Engel assessment method.ResultsThe postoperative examination of 5 patients showed 4 cases of ganglion cell glioma and 1 case of diffuse astrocytoma, the 5 cases were all found with focal cortical dysplasia. Two of the patients had a small amount of bleeding in the operation area and disappeared at the time of discharge. One lesion was located in the left occipital cortex, one in the upper frontal lobe, two in the temporal lobe and hippocampus, and one in the insula. Five cases of epileptic foci were followed up for 5~16 months without seizures, all graded as Engel I.ConclusionsMultimodal assessment system can improve the prognosis of patients with low-grade intracranial tumors with focal cortical dysplasia. In the development of surgical strategies for patients with epilepsy secondary to intracranial tumors, attention should not be paid only to the tumor itself, dysplasia may be associated with tumors, often the underlying cause of epilepsy.
ObjectiveTo explore the clinical characteristics and surgical effect of low-grade glioma (LGG) secondary epilepsy.Methods45 cases of low-grade glioma secondary epilepsy were retrospectively studied during December 2010 and December 2020.There were 27 males and 18 females in this group. Their ages ranged from 10 to 69 years [mean (42.8±15.61) years]. And the illness duration ranged from 3 months to 5 years [mean (12.5±4.12) months]. The initial manifestation of all LGG was seizure attack.All the patients underwent CT and MRI examination before the operation. The LGG was located in the frontal lobe in 17 cases, temporal lobe in 8 cases, parietal lobe in 4 cases, frontal-temporal lobe in 7 cases, frontal-parietal lobe in 5 cases. Meanwhile the LGG was located in the left side in 31 cases, right side in 14 cases. The long-term video-EEG monitoring showed the epileptogenic lesion was located in the ispilateral frontal lobe in 20 cases, temporal lobe in 8 cases, frontal-temporal lobe in 12 cases, frontal-parietal lobe in 5 cases.All the patients were performed operation under the intra-operative electrocorticography (ECoG) monitoring.If necessary, enlarged epileptogenic cortical resection, cortical coagulation or MST was added.After the operation, all the patients were followed-up for half a year to 10 years [mean (4.7±1.83) years] to observe the surgical effect.Results42 cases of LGG underwent gross total resection and 3 subtotal resection intra-operatively. Anterial temporal lobectomy (ALT) was added in 19 cases whose LGG were invovled with temporal lobe.13 cases were added cortical cogulation and 5 cases MST.The post-operative pathology showed astrocytoma grade Ⅰin 20 cases, astrocytoma grade Ⅱ in 12 cases, oligodendroglioma in 11 cases and dysembryoplastic neuroepithelial tumor (DNET) in 2 cases. The post-operative follow-up showed that 30 cases lived well, 12 cases recurred and received re-operation, 3 cases died. Meanwhile, 42 cases were seizure free and 3 cases had occasional seizure attack during the follow-up.ConclusionsTo the patients with LGG secondary epilepsy, if pre-operative long-term EEG monitoring is in accordance with imaging examination, early LGG resection combined with epileptogenic lesion resection should be performed under the guidance of ECoG monitoring.And the post-operative effect is satisfactory.