Surgical outcomes and prognostic factors in epilepsy associated with low-grade brain tumors: a systematic review.
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Low-grade brain tumors such as gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNETs) are common causes of drug-resistant epilepsy, particularly in children and young adults. While surgery is widely used to achieve seizure control, the degree of benefit and prognostic factors remain variably reported across the literature. To systematically evaluate seizure outcomes, extent of resection, and recurrence rates in patients undergoing epilepsy surgery for low-grade brain tumors. We conducted a systematic review of PubMed, Scopus, and Web of Science, following PRISMA 2020 guidelines. Sixty-seven studies involving 4,314 patients met inclusion criteria. Detailed characteristics of all included studies, including outcome definitions, follow-up duration, and key confounders, are provided in Table 2. Data on tumor type, extent of resection, seizure outcomes using Engel or International League Against Epilepsy (ILAE) classifications, recurrence, and complications were extracted. Risk of bias was assessed using the Newcastle–Ottawa Scale. Seizure freedom (Engel Class I or ILAE 1) was frequently reported, with rates often exceeding 70% across studies, with representative cohorts reporting rates of 215/287 at 60 months, 48/51 at a mean 44.2 months, and 20/26 at a mean 49.7 months. Gross total resection (GTR) was often associated with higher reported seizure freedom compared to subtotal resection, although stratified denominators were inconsistently reported across studies. GGs and DNETs showed the most favorable outcomes. Tumor recurrence was infrequently reported, particularly in patients with GTR. Postoperative morbidity was low, with only isolated cases of transient neurological deficits. Epilepsy surgery outcomes are particularly favorable for GGs and DNETs, especially when Gross Total Resection is achieved. Early intervention is associated with better outcomes, and surgery should be considered an early therapeutic option in appropriately selected patients with drug-resistant epilepsy and circumscribed lesions. Standardized reporting and prospective studies are needed to optimize surgical strategies and long-term care.