Predictors of Seizure Outcome After Epilepsy Surgery in Pediatric Patients With Low-Grade Developmental and Epilepsy-Associated Brain Tumors.
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BACKGROUND: Low-grade developmental and epilepsy-associated brain tumors (LEATs) are common causes of childhood-onset drug-resistant focal epilepsies. Although epilepsy surgery shows favorable outcomes in most patients, approximately 20%-30% of them do not become seizure free. This study aimed to identify predictors of postoperative outcomes and seizure recurrence, either spontaneously or after antiseizure medication (ASM) tapering, in a pediatric cohort with LEATs. METHODS: This retrospective cohort study included pediatric patients with LEAT-associated epilepsy who underwent preoperative evaluation and epilepsy surgery at the Medical University of Vienna pediatric epilepsy center from 1993 through 2023. We analyzed the impact of clinical and demographic parameters on spontaneous- or ASM-reduction-related seizure recurrence. RESULTS: In total, 82 patients were included. The median age at surgery was 10.2 years (interquartile range [IQR], 5.3-14.0) and the median follow-up was 60 months (IQR, 36-120); 74.4% of patients became seizure free. ASM discontinuation was successful in 80% of cases. Despite incomplete resections being the strongest predictor of unfavorable outcomes at final follow-up (odds ratio, 53.5; 95% confidence interval = 8.5-337.1; P < 0.001), 33% of patients with unfavorable outcomes had undergone complete resections. These patients had a significantly longer epilepsy duration before surgery than those with incomplete resections and unfavorable outcomes (84.1 vs 12.9 months; P = 0.02). CONCLUSIONS: Complete tumor resection is essential in patients with LEATs. However, especially in patients with longer epilepsy duration, the epileptogenic zone may exceed the epileptogenic lesion, and exclusive resection of the tumor may therefore not be sufficient to achieve seizure freedom. This fact underscores the importance of early preoperative evaluation.