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Long-Term Epilepsy-Associated Tumors (LEATs)

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Surgical Treatment of Epilepsies

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Abstract

Long-term epilepsy-associated tumors (LEATs) constitute a special clinicopathological group of benign brain tumors mainly in temporal and frontal location, which characteristically occur in young age, show a stable course over years, and become symptomatic by a pharmacoresistant epilepsy. Therapeutic goals include both tumor and seizure control. Depending on the relationships between tumor and epileptogenic focus as hypothesized by presurgical workup, different surgical options are available: (1) removal of the tumor only (lesionectomy), (2) removal of the tumor including an intact margin (extended lesionectomy), and (3) tailored resection of the epileptogenic area. With complete removal of the MRI visible tumor (lesionectomy) as the most important prognostic factor, 10-year survival rates of 90% to almost 100% can be achieved. The optimal surgical strategy to achieve seizure control, however, remains controversial. In the absence of robust data from controlled studies only arbitrary recommendations can be given that have proven to be useful in clinical practice. In well delimitable tumors, extended lesionectomy additionally removing an intact margin of 0.5–1.0 cm around the tumor can be recommended providing seizure control in between 70% and 90% of patients. In more diffusely growing tumors infiltrating limbic and/or paralimbic structures, extensive presurgical workup is necessary in order to define the epileptogenic area as well as its functionality and to facilitate an adequate tailored resection.

Tell me and I forget. Teach me and I remember.

Involve me and I learn.

Benjamin Franklin

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    Josef Zentner

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Zentner, J. (2020). Long-Term Epilepsy-Associated Tumors (LEATs). In: Surgical Treatment of Epilepsies. Springer, Cham. https://doi.org/10.1007/978-3-030-48748-5_9

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