Skip to main content

Advertisement

SpringerLink
Log in

Satellite lesions of DNET: implications for seizure and tumor control after resection

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Dysembryoplastic neuroepithelial tumors (DNETs) are a common cause of chronic drug-resistant epilepsy and are known for their favorable surgical outcomes. Nevertheless, the seizure recurrence-free rate is not as favorable if tumorous nodules are present near the main mass. We call these small tumorous nodules in the vicinity of the main mass satellite lesions (SLs). We analyzed tumor and seizure control in the presence and following the subsequent removal of SLs.

Methods

We retrospectively reviewed the medical records, radiological data, and surgical procedures to obtain the outcomes of children who underwent resection surgery for DNET. The analyses were designed to address the associations among the demographic, tumor and seizure-related variables. A Cox proportional hazard model was used for the univariate and multivariate analyses.

Results

In total, 39 consecutive patients were included (26 males and 13 females). SLs were found in 22 patients (56%). The year-to-year analysis of patients with Engel class I was approximately 80% during the follow-up period. However, the actual seizure recurrence-free survival (RFS) rate was 82, 73 and 70% at the first, second and fifth year, respectively. The patients who initially presented with SLs had 46% seizure recurrence rates, while those without SL had 18% seizure recurrence rates.

Conclusions

As the seizure-RFS rate significantly declines over time, a more accurate seizure-free rate analysis using survival curves could be important for determining the outcome of DNET surgery. A thorough review identifying satellite lesions preoperatively and using intraoperative neuronavigation, electrocorticography (ECoG) or intraoperative ultrasonography is warranted to accomplish the wide resection of tumors with accompanying satellite lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets of the current study are available from the corresponding author on request.

References

  1. Blumcke I, Spreafico R, Haaker G, Coras R, Kobow K, Bien CG, Pfafflin M, Elger C, Widman G, Schramm J, Becker A, Braun KP, Leijten F, Baayen JC, Aronica E, Chassoux F, Hamer H, Stefan H, Rossler K, Thom M, Walker MC, Sisodiya SM, Duncan JS, McEvoy AW, Pieper T, Holthausen H, Kudernatsch M, Meencke HJ, Kahane P, Schulze-Bonhage A, Zentner J, Heiland DH, Urbach H, Steinhoff BJ, Bast T, Tassi L, Lo Russo G, Ozkara C, Oz B, Krsek P, Vogelgesang S, Runge U, Lerche H, Weber Y, Honavar M, Pimentel J, Arzimanoglou A, Ulate-Campos A, Noachtar S, Hartl E, Schijns O, Guerrini R, Barba C, Jacques TS, Cross JH, Feucht M, Muhlebner A, Grunwald T, Trinka E, Winkler PA, Gil-Nagel A, Toledano Delgado R, Mayer T, Lutz M, Zountsas B, Garganis K, Rosenow F, Hermsen A, von Oertzen TJ, Diepgen TL, Avanzini G, Consortium E (2017) Histopathological findings in brain tissue obtained during epilepsy surgery. N Engl J Med 377(17):1648–1656. https://doi.org/10.1056/nejmoa1703784

    Article  PubMed  Google Scholar 

  2. Luyken C, Blumcke I, Fimmers R, Urbach H, Elger CE, Wiestler OD, Schramm J (2003) The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 44(6):822–830

    PubMed  Google Scholar 

  3. Fried I, Kim JH, Spencer DD (1994) Limbic and neocortical gliomas associated with intractable seizures: a distinct clinicopathological group. Neurosurgery 34(5):815–824

    CAS  PubMed  Google Scholar 

  4. Maria T, Ingmar B, Eleonora A (2012) Long-term epilepsy-associated tumors. Brain Pathol 22(3):350–379. https://doi.org/10.1111/j.1750-3639.2012.00582.x

    Article  Google Scholar 

  5. Daumas-Duport C, Scheithauer BW, Chodkiewicz J-P, Laws JER, Vedrenne C (1988) Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizuresreport of thirty-nine cases. Neurosurgery 23(5):545–556. https://doi.org/10.1227/00006123-198811000-00002

    Article  CAS  PubMed  Google Scholar 

  6. Louis DN, Perry A, Reifenberger G, Von Deimling A, Figarella-Branger D, Cavenee WK, Ohgaki H, Wiestler OD, Kleihues P, Ellison DW (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131(6):803–820

    PubMed  Google Scholar 

  7. Bonney PA, Boettcher LB, Conner AK, Glenn CA, Briggs RG, Santucci JA, Bellew MR, Battiste JD, Sughrue ME (2016) Review of seizure outcomes after surgical resection of dysembryoplastic neuroepithelial tumors. J Neurooncol 126(1):1–10. https://doi.org/10.1007/s11060-015-1961-4

    Article  PubMed  Google Scholar 

  8. Nguyen HS, Doan N, Gelsomino M, Shabani S (2017) Dysembryoplastic neuroectodermal tumor: an analysis from the Surveillance, Epidemiology, and End Results Program, 2004–2013. World Neurosurgery 103:380–385. https://doi.org/10.1016/j.wneu.2017.04.093

    Article  PubMed  Google Scholar 

  9. Zhang J-g Hu, W-z Zhao R-j, L-f Kong (2014) Dysembryoplastic neuroepithelial tumor: a clinical, neuroradiological, and pathological study of 15 cases. J Child Neurol 29(11):1441–1447. https://doi.org/10.1177/0883073813490831

    Article  PubMed  Google Scholar 

  10. Santos MV, de Oliveira RS, Machado HR (2014) Approach to cortical dysplasia associated with glial and glioneuronal tumors (FCD type IIIb). Child’s Nervous System 30(11):1869–1874. https://doi.org/10.1007/s00381-014-2519-z

    Article  PubMed  Google Scholar 

  11. Daghistani R, Miller E, Kulkarni AV, Widjaja E (2013) Atypical characteristics and behavior of dysembryoplastic neuroepithelial tumors. Neuroradiology 55(2):217–224. https://doi.org/10.1007/s00234-013-1135-z

    Article  PubMed  Google Scholar 

  12. Maher CO, White JB, Scheithauer BW, Raffel C (2008) Recurrence of dysembryoplastic neuroepithelial tumor following resection. Pediatr Neurosurg 44(4):333–336

    PubMed  Google Scholar 

  13. Yasargil MG (1984) Microneurosurgery: operative treatment of CNS tumors 4A. Thieme Stratton, New York

    Google Scholar 

  14. Kim YH, Kim JS, Lee SK, Chung CK (2017) Neurologic outcome after resection of parietal lobe including primary somatosensory cortex: implications of additional resection of posterior parietal cortex. World Neurosurg 106:884–890. https://doi.org/10.1016/j.wneu.2017.07.066

    Article  PubMed  Google Scholar 

  15. Engel J Jr (1993) Outcome with respect to epileptic seizures. In: Engel J Jr (ed) Surgical treatment of the epilepsies. Raven Press, New York, pp 609–621

    Google Scholar 

  16. Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, Moshé SL, Perucca E, Wiebe S, French J (2010) Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE commission on therapeutic strategies. Epilepsia 51(6):1069–1077

    CAS  PubMed  Google Scholar 

  17. Sampetrean O, Maehara T, Arai N, Nemoto T (2006) Rapidly growing dysembryoplastic neuroepithelial tumorcase report. Neurosurgery 59(6):E1337–E1338. https://doi.org/10.1227/01.NEU.0000245621.62721.79

    Article  PubMed  Google Scholar 

  18. Chao L, Tao XB, Jun YK, Xia HH, Wan WK, Tao QS (2013) Recurrence and histological evolution of dysembryoplastic neuroepithelial tumor: a case report and review of the literature. Oncol Lett 6(4):907–914

    PubMed  PubMed Central  Google Scholar 

  19. Nadi M, Ahmad T, Huang A, Hawkins C, Bouffet E, Kulkarni AV (2016) Atypical teratoid rhabdoid tumor diagnosis after partial resection of dysembryoplastic neuroepithelial tumor: case report and review of the literature. Pediatr Neurosurg 51(4):191–198

    PubMed  Google Scholar 

  20. Ray WZ, Blackburn SL, Casavilca-Zambrano S, Barrionuevo C, Orrego JE, Heinicke H, Dowling JL, Perry A (2009) Clinicopathologic features of recurrent dysembryoplastic neuroepithelial tumor and rare malignant transformation: a report of 5 cases and review of the literature. J Neurooncol 94(2):283. https://doi.org/10.1007/s11060-009-9849-9

    Article  PubMed  Google Scholar 

  21. Stokland T, Liu J-F, Ironside JW, Ellison DW, Taylor R, Robinson KJ, Picton SV, Walker DA (2010) A multivariate analysis of factors determining tumor progression in childhood low-grade glioma: a population-based cohort study (CCLG CNS9702). Neuro-Oncology 12(12):1257–1268. https://doi.org/10.1093/neuonc/noq092

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nolan M, Sakuta R, Chuang N, Otsubo H, Rutka J, Or Snead, Hawkins C, Weiss S (2004) Dysembryoplastic neuroepithelial tumors in childhood long-term outcome and prognostic features. Neurology 62(12):2270–2276

    CAS  PubMed  Google Scholar 

  23. Chassoux F, Rodrigo S, Mellerio C, Landre E, Miquel C, Turak B, Laschet J, Meder JF, Roux FX, Daumas-Duport C, Devaux B (2012) Dysembryoplastic neuroepithelial tumors: an MRI-based scheme for epilepsy surgery. Neurology 79(16):1699–1707. https://doi.org/10.1212/WNL.0b013e31826e9aa9

    Article  PubMed  Google Scholar 

  24. Chang EF, Christie C, Sullivan JE, Garcia PA, Tihan T, Gupta N, Berger MS, Barbaro NM (2010) Seizure control outcomes after resection of dysembryoplastic neuroepithelial tumor in 50 patients. J Neurosurg Pediatr 5(1):123–130

    PubMed  Google Scholar 

  25. Sakuta R, Otsubo H, Nolan MA, Weiss SK, Hawkins C, Rutka JT, Chuang NA, Chuang SH, Carter Snead O (2004) Recurrent intractable seizures in children with cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumor. J Child Neurol 19(3):377–384

    Google Scholar 

  26. Qaddoumi I, Ellison DW, Morris EB, Broniscer A, Boop F, Merchant T, Palmer SL, Gajjar A (2010) Dysembryoplastic neuroepithelial tumors and cognitive outcome. Cancer 116(23):5461–5469. https://doi.org/10.1002/cncr.25528

    Article  PubMed  PubMed Central  Google Scholar 

  27. Haydon DH, Dahiya S, Smyth MD, Limbrick DD, Leonard JR (2014) Greater extent of resection improves ganglioglioma recurrence-free survival in children: a volumetric analysis. Neurosurgery 75(1):37–42. https://doi.org/10.1227/neu.0000000000000349

    Article  PubMed  Google Scholar 

  28. Ranger A, Diosy D (2015) Seizures in children with dysembryoplastic neuroepithelial tumors of the brain—a review of surgical outcomes across several studies. Child’s Nervous System 31(6):847–855. https://doi.org/10.1007/s00381-015-2675-9

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bilginer B, Yalnızoglu D, Soylemezoglu F, Turanlı G, Cila A, Topçu M, Akalan N (2008) Surgery for epilepsy in children with dysembryoplastic neuroepithelial tumor: clinical spectrum, seizure outcome, neuroradiology, and pathology. Child’s Nervous System 25(4):485. https://doi.org/10.1007/s00381-008-0762-x

    Article  PubMed  Google Scholar 

  30. Francine C, Catherine D-D (2013) Dysembryoplastic neuroepithelial tumors: where are we now? Epilepsia 54(s9):129–134. https://doi.org/10.1111/epi.12457

    Article  Google Scholar 

  31. Englot DJ, Berger MS, Barbaro NM, Chang EF (2012) Factors associated with seizure freedom in the surgical resection of glioneuronal tumors. Epilepsia 53(1):51–57. https://doi.org/10.1111/j.1528-1167.2011.03269.x

    Article  PubMed  Google Scholar 

  32. Thom M, Toma A, An S, Martinian L, Hadjivassiliou G, Ratilal B, Dean A, McEvoy A, Sisodiya SM, Brandner S (2011) One hundred and one dysembryoplastic neuroepithelial tumors: an adult epilepsy series with immunohistochemical, molecular genetic, and clinical correlations and a review of the literature. J Neuropathol Exp Neurol 70(10):859–878. https://doi.org/10.1097/NEN.0b013e3182302475

    Article  CAS  PubMed  Google Scholar 

  33. Giulioni M, Rubboli G, Marucci G, Martinoni M, Volpi L, Michelucci R, Marliani AF, Bisulli F, Tinuper P, Castana L, Sartori I, Calbucci F (2009) Seizure outcome of epilepsy surgery in focal epilepsies associated with temporomesial glioneuronal tumors: lesionectomy compared with tailored resection. J Neurosurg 111(6):1275–1282. https://doi.org/10.3171/2009.3.Jns081350

    Article  PubMed  Google Scholar 

  34. Nitin T, Yoshua E (2013) Resection strategies in tumoral epilepsy: is a lesionectomy enough? Epilepsia 54(s9):72–78. https://doi.org/10.1111/epi.12448

    Article  Google Scholar 

  35. André P, Eliseu P, Duval SV (2013) Developmental tumors and adjacent cortical dysplasia: single or dual pathology? Epilepsia 54(s9):18–24. https://doi.org/10.1111/epi.12438

    Article  Google Scholar 

  36. Rivera B, Gayden T, Carrot-Zhang J, Nadaf J, Boshari T, Faury D, Zeinieh M, Blanc R, Burk DL, Fahiminiya S, Bareke E, Schuller U, Monoranu CM, Strater R, Kerl K, Niederstadt T, Kurlemann G, Ellezam B, Michalak Z, Thom M, Lockhart PJ, Leventer RJ, Ohm M, MacGregor D, Jones D, Karamchandani J, Greenwood CM, Berghuis AM, Bens S, Siebert R, Zakrzewska M, Liberski PP, Zakrzewski K, Sisodiya SM, Paulus W, Albrecht S, Hasselblatt M, Jabado N, Foulkes WD, Majewski J (2016) Germline and somatic FGFR1 abnormalities in dysembryoplastic neuroepithelial tumors. Acta Neuropathol 131(6):847–863. https://doi.org/10.1007/s00401-016-1549-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Qaddoumi I, Orisme W, Wen J, Santiago T, Gupta K, Dalton JD, Tang B, Haupfear K, Punchihewa C, Easton J (2016) Genetic alterations in uncommon low-grade neuroepithelial tumors: BRAF, FGFR1, and MYB mutations occur at high frequency and align with morphology. Acta Neuropathol 131(6):833–845

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Blümcke I, Aronica E, Becker A, Capper D, Coras R, Honavar M, Jacques TS, Kobow K, Miyata H, Mühlebner A (2016) Low-grade epilepsy-associated neuroepithelial tumours—the 2016 WHO classification. Nat Rev Neurol 12(12):732

    PubMed  Google Scholar 

  39. Lee JH, Huynh M, Silhavy JL, Kim S, Dixon-Salazar T, Heiberg A, Scott E, Bafna V, Hill KJ, Collazo A (2012) De novo somatic mutations in components of the PI3 K-AKT3-mTOR pathway cause hemimegalencephaly. Nat Genet 44(8):941

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Lim JS, W-i Kim, Kang H-C, Kim SH, Park AH, Park EK, Cho Y-W, Kim S, Kim HM, Kim JA (2015) Brain somatic mutations in MTOR cause focal cortical dysplasia type II leading to intractable epilepsy. Nat Med 21(4):395

    CAS  Google Scholar 

Download references

Acknowledgements

We thank our patients and their families for their kind contribution to the research.

Author information

Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Jeyul Yang, Seung-Ki Kim, Kyu-Chang Wang & Ji Hoon Phi

  2. Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Republic of Korea

    Ki Joong Kim, Jong Hee Chae & Byung Chan Lim

  3. Department of Pathology, Seoul National University Children’s Hospital, Seoul, Republic of Korea

    Sung-Hye Park

Authors
  1. Jeyul Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seung-Ki Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ki Joong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jong Hee Chae
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Byung Chan Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kyu-Chang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sung-Hye Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ji Hoon Phi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JY, SKK, KCW, JHP contributed to the design, data analysis, manuscript drafting and editing of the study. KJK, JHC, BCL, SHP contributed to acquisition and analysis of data. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Ji Hoon Phi.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Ethical approval

This study was approved by the Institutional Review Board (IRB) of the Seoul National University Hospital (Approval No. H-1807-067-958). Obtaining Informed consent was waived by the IRB.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, J., Kim, SK., Kim, K.J. et al. Satellite lesions of DNET: implications for seizure and tumor control after resection. J Neurooncol 143, 437–445 (2019). https://doi.org/10.1007/s11060-019-03174-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-019-03174-3

Keywords

Search

Navigation