Abstracts

Rationale: To review clinical features and surgical outcome in patients with temporal lobe pleomorphic xanthoastrocytomas (PXAs) and intractable epilepsy. Methods: The Rush Surgical Epilepsy Database was queried to identify patients with chronic, intractable epilepsy who underwent resection of a temporal lobe PXA at Rush University Medical Center. Medical records were reviewed for age of seizure onset, delay to surgery, seizure frequency and characteristics, extent of resection, complications, length of follow-up, seizure improvement, and post-operative MRI findings. Results: 5 patients were identified with a temporal lobe PXA and intractable epilepsy. Average age of seizure onset was 18.6 years and delay to surgery was 73 months. Complex partial seizures were the most common presenting symptom, shown in all 5 patients, while 3 of 5 patients presented with simple partial seizures. Seizures occurred with an average frequency of 3.5 per month (Range .33 to 12 per month). Detailed operative and post-operative follow up data was available for all 5 patients. Resections were performed on the left side in 4 patients. Partial resection of the temporal lobe was performed in 3 cases. Three of all cases had complete resection of the amygdala, and only 1 required resection in multiple areas (complete resection of amygdala and partial resection of the hippocampus). Long-term follow up was available for 4 of the 5 patients. Average follow-up was 120 months (range 29 - 296 months) with all 4 patients achieving Engel’s class I outcome. At last follow up, there was no radiographic or clinical evidence of tumor recurrence. Serious or permanent complications were noted in none of the patients. Conclusions: Temporal lobe pleomorphic xanthoastrocytomas causing chronic, intractable epilepsy occur in younger patients and demonstrate excellent results in seizure improvement and tumor control with surgery.