Multimodal Preoperative Evaluation And Surgical Treatment For Patients With Epilepsy-related Developmental Brain Tumors

Objective:To analyze the surgical outcome of patients with epilepsy-related developmental brain tumors under the multimodal epilepsy evaluation system.Data and Methods: Retrospective analysis was performed on the data of patients with developmental brain tumor confirmed by pathology after neurosurgical treatment in lanzhou university second hospital.All patients presented with seizures.Multimodal epilepsy evaluation system first stage I evaluation,including the analysis of Symptomatology,structure,and(or)metabolic imaging and VEEG analysis results,Using the principle of identity between clinic ? electrophysiology and anatomy,Combined with the stage I evaluation to determine the surgical plan,select some patients for intracranial deep electrode implantation.All patients underwent intraoperative ECoG monitoring to determine the consistency of epileptic zone before surgical resection.Postoperative follow-up was conducted regularly to review MRI for tumor recurrence,Engel grade for epilepsy control rate,Montreal cognitive assessment scale and Hamilton depression/anxiety scale for postoperative neurocognitive function and psychological evaluation.Patients were divided according to follow-up results:1.Good prognosis group(Engel ?);2.Poor prognosis group(Engel II-IV).Grouping data were processed by SPSS20.0 software and combined with literature analysis.Results: During the phase I evaluation,25 of the 30 patients had predetermined epileptic zone that were consistent,and the 5 patients who did not meet the criteria were identified after SEEG electrode implantation during the phase II evaluation.Thirty patients successfully completed the resection of the epileptic zone.According to the follow-up grouping results: 1.Good prognosis group(Engel I)27 cases;2.Poor prognosis group(Enge II-IV)3 cases,the postoperative completeno seizure rate was 90%.Among the 5 patients who underwent SEEG implantation,the Engel grade was Ia.Postoperatively,the Montreal Cognitive Assessment Scale showed that 3 patients had varying degrees of cognitive impairment(<30 points);the Hamilton scale showed that 3 of them were grade II(may have anxiety/depression).According to pathological grouping,the control rate of epilepsy in patients with DNT was 90%(18/20),GG was 90%(1/10),and the 9 patients with FCD was 66.6%(6/9).There were no cases of tumor recurrence and malignant transformation during follow-up,but 2 cases of patients with anaplastic ganglion glioma(WHO III)underwent regular chemotherapy after surgery,and the condition is stable.Statistical analysis found that only " the course of disease ","surgical simple lesion resection and lesion enlargement resection" and "whether pathology was accompanied by FCD" had statistically differences in Engel grade of postoperative epilepsy(P values were 0.041,0.009 and 0.021<0.05,respectively).Conclusion:1.Multimodal multi-parameter epilepsy evaluation system has important guiding value for intracranial electrode implantation and epileptogenic zone resection;2.Stereotactic deep electrode implanted EEG monitoring and intraoperative cortical EEG monitoring can improve the accuracy to localize of epileptic zone and reduce postoperative epilepsy control rate in patients with epilepsy-related developmental brain tumors;3.Epileptic-related developmental brain tumors are often associated with focal cortical dysplasia,which may be one of the factors leading to epileptic seizures.Surgical treatment of tumors and epileptic zone,total resection of tumors and epileptic zone in patients with early course of disease(<1 year)after evaluation of epilepsy will bring more benefits to patients after surgery.