AANS 2017: Seizure Outcome After Surgical Resection of Insular Glioma
Winner of the Journal of Neuro-Oncology Award sponsored by Kluwer Academic Publishers, Doris Du Wang, MD, PhD, a resident in the Department of Neurological Surgery at the University of California San Francisco (UCSF), presented her research on seizure outcome after surgical resection of insular glioma during the 2017 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.
A majority of patients with insular tumors present with seizures, and although a number of studies have shown that greater extent of resection improves overall patient survival, few studies have documented postoperative seizure control after insular tumor resection. The aim of this study was to characterize seizure control rates in patients undergoing insular tumor resection, identify predictors of seizure control, and evaluate the association between seizure recurrence and tumor progression.
The study population included adults who had undergone resection of World Health Organization grade II, III, or IV insular gliomas between 1997 and 2015 at UCSF. Preoperative seizure characteristics, tumor characteristics, surgical factors, and postoperative seizure outcomes were reviewed.
Study Findings
Of 287 patients who underwent insular glioma resection, 64% presented with seizures and 92 patients with sufficient clinical data were included. At 1 year after surgery, 67% were completely seizure-free and 87% were free from disabling seizures. At final follow-up, 38% were seizure-free and 75% were free from disabling seizures.
Multivariate proportional hazard analysis revealed that later seizure onset age, greater extent of resection, and longer time to tumor progression were significant predictors of seizure freedom. Seizure recurrence was significantly associated with tumor progression. Repeat resection offered additional seizure control, as 9 of the 21 patients (43%) with recurrent seizures became seizure free after reoperation.
The conclusion of the study was to recommend maximizing the extent of resection in insular gliomas as it not only offers survival benefit, but also portends greater seizure freedom after surgery. Seizure recurrence is predictive of tumor progression, and repeat operation can lead to additional seizure control.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
