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• W2317016790 abstract "To the Editor: We read with great interest the paper by Ramantani et al.1 We congratulate the authors for their excellent analysis of the seizure and cognitive outcome of a series of children who underwent resective surgery for glioneuronal tumor–associated refractory epilepsy. We agree with the authors that the optimal timing for surgical intervention in children with glioneuronal tumors remains unclear, and it is still a matter of debate. Furthermore, we agree on the importance of early surgical treatment able to guarantee a good seizure outcome and to prevent cognitive disorders. However, we think that when discussing surgical strategies and seizure outcome in the setting of an epilepsy-associated tumor, more attention should be paid to the anatomic location of tumor.2 In our experience, in both adult and pediatric series,3-7 in addition to neurophysiological study, the anatomic location of an epilepsy-associated glioneuronal tumor is an important factor to be considered when choosing the optimal surgical strategy. Lesionectomy may be sufficient for optimal seizure outcome in temporolateral and extratemporal glioneuronal tumor. In contrast, to achieve seizure freedom for temporomesial glioneuronal tumor associated with epilepsy, a tailored resection is often necessary.5-7 Temporomesial glioneuronal tumors generally have a characteristic anatomic location in the uncus/amygdala/entorhinal zone, and sometimes they involve the hippocampal head.5,6 These aspects support the hypothesis that temporomesial glioneuronal tumors are related to a more widespread epileptic network and define a distinct anatomoclinicopathological group with complex epileptogenic mechanisms.5-9 From a surgical point of view, a controversial issue is the resection of temporomesial structures, particularly the hippocampal-parahippocampal complex in addition to the tumor, especially when the hippocampi are not involved in the lesion and appear normal on magnetic resonance imaging. However, it is well-known that the medial temporal lobe, specifically the hippocampus and the entorhinal cortex, have a greater epileptogenicity and that the amount of tissue resected in temporomesial operations is considered crucial for surgical success in temporomesial lobe epilepsy.10,11 Our good seizure outcome results in temporomesial glioneuronal tumor treated by a tailored resection5-7 suggests that the epileptogenic focus is often larger than the extrahippocampal lesion. These findings support the concept that in the temporomesial lobe, both the lesion and hippocampus are often epileptogenic, even if magnetic resonance imaging does not reveal hippocampal atrophy or sclerosis and histological examination shows normal features in the majority of cases.5-7 In accord with the authors, we suggest avoiding loss of time in the planning of surgical treatment for focal epilepsy associated with glioneuronal tumors. In fact, a longer duration of epilepsy has been associated with a poorer postoperative seizure outcome12 and, as the authors demonstrated, with a detrimental effect on cognitive functioning. In our opinion, because glioneuronal tumors constitute a surgically remediable cause of focal epilepsy, frequently at a young age, and because modern imaging techniques allow early identification of these lesions, surgical treatment should be offered early, regardless of the response to medical treatment, to avoid cognitive dysfunction, psychosocial consequences of persistent seizures, adverse effects of pharmacological treatment, and even to prevent the risk, although low, of tumor growth and possible malignant transformation.3-7,13-15 Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article." @default.
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• W2317016790 date "2014-08-01" @default.
• W2317016790 modified "2023-10-10" @default.
• W2317016790 title "Avoid Loss of Time" @default.
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• W2317016790 doi "https://doi.org/10.1227/neu.0000000000000395" @default.
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