Epilepsy surgery following brain tumor resection in children.

Object: Intractable epilepsy following successful brain tumor surgery in children may have several underlying causes such as residual tumor, cortical dysplasia, and gliosis. The authors reviewed the cases of children who had previously undergone resection of a brain tumor only to have medically refractory seizures postoperatively.

Methods: The authors performed a retrospective case review of 9 children who underwent brain tumor surgery 2-13 years before undergoing a second surgery to try and control their seizures.

Results: Eight of 9 children had seizures at the time of tumor presentation. Tumor types included ganglioglioma, dysembryoplastic neuroepithelial tumor, pilocytic astrocytoma, oligodendroglioma, ependymoma, and choroid plexus papilloma. All patients achieved a seizure-free interval before intractable seizures recurred. After the second operation, 3 children were seizure free, 1 only had auras, 2 had rare complex partial seizures, and 3 continued to have relatively frequent seizures, although the frequency and severity were reduced. Seven of 9 patients had pathology showing residual tumor.

Conclusions: Epilepsy surgery following earlier brain tumor surgery can provide substantial benefit with reduced seizure number and severity. Despite reassuring brain imaging results, residual tumor was present more often than expected in pathological specimens.