Back to Search
Start Over
Dysembryoplastic neuroepithelial tumors: an MRI-based scheme for epilepsy surgery.
- Source :
-
Neurology [Neurology] 2012 Oct 16; Vol. 79 (16), pp. 1699-707. Date of Electronic Publication: 2012 Oct 03. - Publication Year :
- 2012
-
Abstract
- Objective: To determine optimal resections in the 3 dysembryoplastic neuroepithelial tumor (DNT) histologic subtypes (simple, complex, and nonspecific) based on MRI features.<br />Methods: In 78 consecutive epilepsy patients operated for DNT, MRI features were classified as follows: type 1 (cystic/polycystic-like, well-delineated, strongly hypointense T1), type 2 (nodular-like, heterogeneous), or type 3 (dysplastic-like, iso/hyposignal T1, poor delineation, gray-white matter blurring). Correlations between histology, neurophysiologic findings, and surgical outcome were established for each MRI subtype.<br />Results: Type 1 MRI (25 cases, in temporal and extratemporal areas) always corresponded to simple or complex DNTs. Type 2 MRI (25 cases, predominantly in neocortical areas) and type 3 MRI (28 cases, mainly in the mesial temporal lobe) corresponded to nonspecific forms. The epileptogenic zone (EZ) differed significantly according to the MRI subtype (p = 0.0029). It colocalized with the tumor in type 1 MRI, included perilesional cortex in type 2 MRI, and involved extensive areas in type 3 MRI. Cortical dysplasia was predominantly found in type 3 MRI (p < 0.0001). The main prognostic factors for seizure-free outcome (83%) were complete tumor (p < 0.0001) and EZ (p = 0.0115) removal. Other factors favorably influencing the outcome were a short epilepsy duration (p = 0.013) and absence of cortical-subcortical damage at the resection site (p = 0.053). Age at surgery was not related to outcome; however, cortical-subcortical damage was correlated with old age (p = 0.021). Treatment discontinuation was correlated with young age at surgery (p = 0.004) and short epilepsy duration (p = 0.001).<br />Conclusion: We propose that resection might be restricted to the tumor in type 1 MRI and be more extensive in other MRI subtypes, especially in type 3 MRI. Early surgery and clean surgical margins are crucial for curing epilepsy.
- Subjects :
- Adolescent
Adult
Age of Onset
Brain pathology
Brain Neoplasms complications
Brain Neoplasms pathology
Carcinoma complications
Carcinoma pathology
Child
Drug Resistance
Electroencephalography
Epilepsy etiology
Epilepsy pathology
Female
Humans
Male
Middle Aged
Seizures surgery
Treatment Outcome
Young Adult
Brain Neoplasms surgery
Carcinoma surgery
Epilepsy surgery
Magnetic Resonance Imaging methods
Neurosurgical Procedures methods
Surgery, Computer-Assisted methods
Subjects
Details
- Language :
- English
- ISSN :
- 1526-632X
- Volume :
- 79
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- Neurology
- Publication Type :
- Academic Journal
- Accession number :
- 23035071
- Full Text :
- https://doi.org/10.1212/WNL.0b013e31826e9aa9