Tumores associados à epilepsia de longa duração do lobo temporal: parâmetros clínicos, neurofisiológicos, de neuroimagem, histopatológicos e prognóstico cirúrgico

• Autor(a) principal: Odreman, Marlene Del Valle Maiz [UNIFESP]
• Data de Publicação: 2021
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=10699752; https://repositorio.unifesp.br/handle/11600/68316
• topic: Long-Term Epilepsy-Associated Tumors; Refractory Epilepsy; Tumor Satellites; Focal Cortical Dysplasia; Surgical Outcome; Tumores Associados À Epilepsia De Longa Duração; Epilepsia Refratária; Satélites Tumorais; Displasias Corticais Focais; Prognóstico Cirúrgico

Low-grade neoplasms of the central nervous system are the most common solid tumors found in childhood and among children under 19 years old and represent an essential etiological group of epilepsy refractory to clinical treatment. Thirty percent of patients with epilepsy refractory to antiseizure medicines have neuroepithelial neoplasms, among which gangliogliomas and dysembrioplastic neuroepithelial tumors are the most frequently recognized entities. Objective: At the time of presurgical workup, we evaluated whether the clinical, electrophysiological, neuroimaging, and histopathological characteristics in a series of patients with temporal lobe long-term epilepsy-associated tumors (LEATs) could predict the postsurgical seizure outcome. Methods: in a retrospective study, we included the medical records of 22 patients, which were divided according to their surgical outcome in remission (Engel IA) and non-remission (Engel IBIII) groups. Results: sixty-eight percent of the patients were complete seizure-free after surgery. Those with an unfavorable surgical outcome presented focal to bilateral tonicclonic seizures (FBTCS, p=0.01), more diffuse lesions (p=0.07), and residual tumors (p=0.02) on the MRI. They also had more tumor infiltration towards the anterior temporal cortex (p=0.03), parahippocampus (p=0.03), basal ganglia (p=0.08), and insula (p=0.09). Electroencephalographic/electrocorticographic (EEG/ECoG) patterns suggestive of cytoarchitectural abnormalities were observed in MRI negative LEATs satellites (3/5) and, to a lesser extent, in focal cortical dysplasia (FCD, 1/2). Conclusion: the initial evaluation of patients with LEATs might permit us to predict surgical results. Factors such as the presence of FBTCS, tumors with diffuse margins on MRI, and infiltration of potentially unresectable structures are associated with persistent seizures after surgery; LEATs with additional tissue abnormalities may show EEG/ECoG patterns suggestive of FCDs, due to the high frequency of tumor satellites in LEATs, ECoG-guided resection is particularly important for a good outcome.