Authors :
Presenting Author: Dina Ghandour, MBChB – Northwestern University
Mary Margaret Mizera, BSN – Northwerstern University
Jason Hseih, MD – Northwestern University
Jessica Templer, MD – Northwestern University
Cody Nathan, MD – Northwestern University
Rationale:
Pleomorphic xanthoastrocytomas (PXA) are rare brain tumors that are associated with epilepsy. There is a paucity of data on epilepsy outcomes, particularly in adults, with this type of tumor who undergo surgical treatment. We describe a case of frontal PXA and conduct a systematic review to examine the seizure outcomes following resection of PXAs.
Methods:
A single case study is presented to describe the clinical manifestations, imaging characteristics and neurophysiologic features of a left frontal PXA.
A systematic review following PRISMA guidelines was performed, and studies were included if they reported seizure outcomes following surgical intervention. We searched the PubMed database for papers published between 1990-2025.
Results:
A 24-year-old female patient presented following a tonic-clonic seizure. MRI revealed a left frontal enhancing lesion. PET CT showed an area of hypometabolism in the left frontal cortex superior to the hypermetabolic lesion. EEG showed left frontocentral sharp waves and left fronto-temporal seizures were recorded. One electro-clinical seizure was recorded characterized by right head version that progressed to generalized tonic-clonic seizure while other seizures were subclinical. The patient underwent electrocorticography (ECoG)-guided resection, with multifocal repetitive spiking seen posterior to the lesion (Figure 1). Post resection, no epileptiform discharges were seen on ECoG. The pathology was consistent with PXA, WHO Grade 2. The patient remained seizure free one month post-operatively on one anti-seizure medication without tumor recurrence.
The initial review identified 397 articles; 230 duplicates were excluded, 137 of the 167 remaining were excluded after title/abstract review, 17 of the remaining 30 studies were excluded in full-text review yielding 13 studies (Table 1). The most common location of PXA was temporal lobe, followed by frontal lobe. Age at presentation ranged from 4-43 years old. The most common seizure types were focal impaired aware, and generalized tonic-clonic seizures. Reported seizure freedom rates post operatively ranged from 62.5-100%, however, reporting of seizure outcome was variable across studies. Some studies utilize the Engel classification system while others only report seizure freedom in varying follow up periods. Five papers report the use of ECoG during the resection, all of which report seizure freedom post-operatively. Papers reporting no tumour recurrence were associated with a favorable seizure outcome. No data is available on the appropriate timing of anti-seizure medication weaning.
Conclusions:
Both the systematic review and our case highlight that ECoG guidance, gross total resection, and lack of tumor recurrence are associated with favourable seizure outcomes in patients with epilepsy secondary to PXAs. Further data is needed to discern the appropriate time to wean anti-seizure medications after resection. Furthermore, standardized reporting of post-surgical epilepsy outcomes is needed.
Funding: None