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Recurrent Intractable Seizures in Children With Cortical Dysplasia Adjacent to Dysembryoplastic Neuroepithelial Tumor

Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada, sakuta{at}dokkyomed.ac.jp., Department of Pediatrics, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya, Saitama, Japan

Hiroshi Otsubo, MD

Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Melinda A. Nolan, MD

Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Shelly K. Weiss, MD

Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Cynthia Hawkins, MD

Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

James T. Rutka, MD, PhD

Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Nathaniel A. Chuang, MD

Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Sylvester H. Chuang, MD

Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

O. Carter Snead, MD

Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

The purpose of this study was to identify the pathologic features that predict postoperative outcome in children with cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumors. We reviewed the records of children with dysembryoplastic neuroepithelial tumor who underwent epilepsy surgery and who had at least 1 year of surgical follow-up. We divided the dysembryoplastic neuroepithelial tumors into three pathology classes (simple, complex, and nonspecific), categorized adjunctive cortical dysplasia into four types, and compared histopathology with seizure outcomes. We identified 26 children with dysembryoplastic neuroepithelial tumors. Dysembryoplastic neuroepithelial tumors were complex in 19 patients (73%), simple in 6 (23%), and nonspecific in 1 (4%). Cortical dysplasia was adjacent to dysembryoplastic neuroepithelial tumors in 18 patients. Six patients had type IA cortical dysplasia, 5 had type IB, 3 had type IIA, and 1 had type IIB. The 3 remaining patients had repeated surgeries; of these, 2 patients had cortical dysplasias of type IA/IB and 1 was type IIA/IIB. Eight (39%) of 18 patients with dysembryoplastic neuroepithelial tumors and cortical dysplasia required further surgery for recurrent intractable seizures (P < .05), whereas none of 8 patients without cortical dysplasia required additional surgery. Of 13 patients with type I cortical dysplasia, only 4 had a poor seizure outcome, whereas all 5 patients with type II had a poor seizure outcome postoperatively (P < .05). Children with dysembryoplastic neuroepithelial tumor and cortical dysplasia often had recurrent intractable seizures postoperatively and required further epilepsy surgery. Cortical dysplasia adjacent to dysembryoplastic neuroepithelial tumor can play a role in the epileptogenicity of dysembryoplastic neuroepithelial tumor. Complete resection of a dysembryoplastic neuroepithelial tumor and its adjacent cortical dysplasia should be considered. (J Child Neurol 2005;20:377—384).

Journal of Child Neurology, Vol. 19, No. 3, 377-384 (2004)
DOI: 10.1177/08830738040190031801


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