• Megan E H Still, Alexandre Roux, Gilles Huberfeld, Luc Bauchet, Marie-Hélène Baron, Denys Fontaine, Marie Blonski, Emmanuel Mandonnet, Remy Guillevin, Jacques Guyotat, Luc Taillandier, Laurent Capelle, Hugues Duffau, and Johan Pallud.
• Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
• Neurosurgery. 2019 Aug 1; 85 (2): E332-E340.

BackgroundEpileptic seizures impair quality of life in diffuse low-grade glioma (DLGG) patients. Tumor resection significantly impacts postoperative seizure control, but the precise extent of resection (EOR) required for optimal seizure control is not clear yet.ObjectiveTo identify the EOR and residual tumor volume that correlated to postoperative seizure control, defined as a total seizure freedom (Class 1A in reference to Engel classification system) with and without antiepileptic drugs in patients undergoing surgical resection of supratentorial DLGG.MethodsA retrospective review was conducted of all patients who underwent first-line surgical resection of supratentorial DLGG who presented with preoperative seizures without adjuvant oncological treatment. EOR and residual tumor volume were quantified from pre- and post-operative magnetic resonance imagings. Receiver operating characteristic curves were plotted to determine the EOR and residual tumor volume that corresponded to optimal postoperative seizure control.ResultsOf the 346 included patients, 65.5% had controlled seizures postoperatively, with higher age at resection (adjusted OR per unit, 1.03 [95% confidence interval:1.01-1.06], P = .043) and higher percentage of resection (adjusted OR per unit, 1.02 [95% confidence interval:1.00-1.03], P < .001) found as independent predictors of postoperative seizure control. Optimal EOR was ≥91% and optimal residual tumor volume was ≤19 cc to improve postoperative seizure control.ConclusionPostoperative seizure control is more likely when EOR is ≥91% and/or when residual tumor volume is ≤19 cc in supratentorial DLGG gliomas who present with seizures. Resected peritumoral cortex should, however, be taken into account in future studies.Copyright © 2018 by the Congress of Neurological Surgeons.

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