Navegando por Palavras-chave "Glioneuronal"

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    Avaliação de anticoncepção em mulheres com epilepsia
    (Universidade Federal de São Paulo (UNIFESP), 2014-12-17) Hatty, Juliana Halley [UNIFESP]; Guazzelli, Cristina Aparecida Falbo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To define two different groups of neurosurgical patients with low-grade neuroepithelial brain tumors regarding the presence of medically refractory epilepsy (group A) or absence of medically refractory epilepsy (group B). To identify the characteristics and to define the differences between these groups in the clinical and surgical aspects. To measure the surgical impact in the control of medically refractory epilepsy. To describe the biological behavior of tumors in both groups. Methods: This paper retrospectively evaluate a cohort of patients who underwent resection or biopsy for low-grade gliomas and glioneuronal tumors in the Discipline of Neurosurgery at the Federal University of São Paulo between 2003 and 2013. The histologically proved tumors as grades I and II, according to the World Heath Organization (WHO) classification, were selected. The patients were stratified in two groups regarding the presence of medically refractory epilepsy (group A) or absence of medically refractory epilepsy (group B). The postoperative seizure control is evaluated in the group A with the Engel scale and the related factors are investigated. The biological tumor behavior is analyzed in both groups with measurement of the progression free survival, Kaplan-Meier curves for recurrence and, mortality rates. Results: A total of 76 patients with low grade tumors were selected and divided in group A (48 patients) and group B (28 patients) with a median follow-up of 4,2 years. Statistical analysis between groups A and B showed difference for the age at operation (23,5 vs 36,2 years), age at symptoms onset (15 vs 33,9 years) and duration of symptoms (8,4 vs 2,4 years),(p<0,001). In group A the temporomesial location was more common (63% vs 32%),(p=0,01) and in group B the extratemporal (24% vs 68%) and multilobar location (6% vs 54%),(p<0,001) were more prevalent. Regarding the histology, the group A was more affected by grade I tumors and glioneuronal histology (71% vs 0%), while group B had a higher prevalence of grade II gliomas (25% vs 86%)(p<0,001). There was a difference for the frequency of gross total resection (75% vs 7%),(p<0,001), mortality (0% vs 25%),(p<0,001) and recurrence (15% vs 39%),(p<0,003) between groups. In the group with refractory epilepsy, gross total resection and glioneuronal histology were predictive of longterm seizure control, (p=0,03). Conclusions: The patients with medically refractory epilepsy are younger, have longer period of symptoms and typically have !xvii temporomesial glioneuronal tumors, in which the gross total resection is usually possible. The patients without medically refractory epilepsy usually comprises grade II gliomas with more extratemporal and multilobar locations. The recurrences are earlier and the mortality rate is higher in this group. Gross total resection and glioneuronal histology are predictive of long-term seizure control in medically refractory epilepsy patients.