Abstracts

Rationale: Low-grade neuroepithelial tumors (LGNTs), such as dysembryoplastic neuroepithelial tumors (DNETS) and gangliogliomas are well known to be associated with epilepsy, and resection of these lesions is thought to be highly curative. Over the span of 15 years, we identified several other unusual low-grade tumors causing epilepsy. The slow growing nature of these tumors allowed them to be cured surgically and here we report on the clinical features, management and outcomes following such resections. Methods: We compiled a list of all patients with intractable seizures that were treated at Memorial Hermann Hospital in the Texas Medical Center by a single neurosurgeon from 2004 to 2019. Patients were included if they had a histologic confirmation of a low-grade tumor. For the patients that met these criteria, relevant clinical and demographic data were compiled (Table 1). Patients in whom pathology reports were not available, such as patients who underwent laser thermal ablation or had a previously resected tumor, with only gliosis on pathology were excluded. Results: From our database we identified 13 DNETs, 7 gangliogliomas, 6 meningiomas, 3 glioneuronal tumors not otherwise characterized, 3 angiocentric gliomas and 2 hamartomatous formation characterized as mengioangiomatosis. These last three entities are rare lesions that commonly present with epilepsy as their leading clinical symptom. The rarity of these lesions means their clinical presentations and long-term prognoses are not well-defined. Further evaluation of the key clinical features of these lesions could help elucidate improvements in the management of these patients. There was an even split in gender among patients with an angiocentric glioma. While the mean age of presentation was 20.4 years old, it should be noted that one of the patients was middle-aged and the other two were pediatric patients. All patients underwent a gross total resection (GTR). All five of the patients with either meningiomatosis or angiocentric gliomas were seizure-free after surgery with an Engel classification of 1a. Conclusions: Consistent with previously reported outcomes of angiocentric glioma and mengioangiomatosis, the patients in our study were seizure free following resection. While one of the patients suffered from a focal neurological deficit following resection, the majority reported no complications with Patient A showing improvement. By studying these rare tumors, we hope to inform future refinement of post-operative clinical management of these patients. Studying the clinical presentations and post-surgical outcomes may have implications for delineating epileptic pathways in this subset of tumors and how they may relate to other LGNTs. Funding: No funding