Results of surgical treatment of patients with epilepsy associated with brain tumors

SUMMARY. Epileptic seizures are a serious cause of impaired quality of life in patients with intracerebral tumors. Most often, the disease manifests precisely with an epileptic seizure. More than 50 % of patients experience at least one seizure during their illness, and more than 30 % develop tumor-related epilepsy. Low-grade intracerebral tumors are more likely to cause epileptic seizures than high-grade intracerebral tumors, although the reasons for this are still unclear.

PURPOSE OF THE STUDY: to analyze the incidence of symptomatic epilepsy in patients with neuroepithelial tumors, to study the factors influencing the development of epilepsy, to evaluate the effect of intraoperative neurophysiological monitoring on the volume and tactics of surgical treatment, to study the dynamics of epileptic seizures in the postoperative period.

MATERIALS AND METHODS. Cases of 336 patients with primary neuroepithelial brain tumors of supratentorial localization for 2017–2022, operated at the N.N. prof. A. L. Polenov were analyzed. Criteria were assessed such as the degree of malignancy of the tumor (tumors of low grade (LG) Grade 1, 2 and high grade (HG) Grade 3, 4), type of seizures (generalized, partial), localization and extent of surgical resection of the tumor, intraoperative detection epileptogenic foci by electrocorticography (ECoG) and type of foci resection, control of seizures in the early postoperative period. Follow-up was studied in 69 patients in terms of 13 to 25 months. The results of epilepsy treatment were assessed using the Engel scale.

RESULTS. Symptomatic epilepsy was detected in 170 (50.6 %) of 336 examined patients with neuroepithelial tumors. In the group of patients with LG tumor, epilepsy was more common (63 %). Intraoperative corticography was performed in 113 (67 %) of patients with epilepsy. The absence of seizures (Engel class I) was observed in the group of LG tumor in 38 %, HG tumor in 3 % of cases, improvement (Engel II, III) LG tumor — 38 %, HG tumor — 17 %, without improvement (Engel IV) HG tumor 3 %.

CONCLUSION. Neuroepithelial tumors are highly epileptogenic (47 %). The development of epileptic seizures in this group of patients associated with the spread of the tumor to functionally significant areas. The absence of seizures was more often observed in patients with low grade tumors and more radical resection of the tumor.

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