Differential diagnosis of the epileptogenic supratentorial brain tumors in children

Fifty-six out of 79 pediatric patients with supratentorial brain tumors were noted to have symptomatic epilepsy. Dysembryoplastic neuroepithelial tumors (DNET), diffuse astrocytomas (DA), and gangliogliomas (GG) were the most epileptogenic tumors. Seizures were new-onset in all our noted cases of DNET and in 4 patients with GG and the only clinical tumor sign in 6 of 8 cases of DNET. The neuroimaging features of the MRI pattern of DNET, DA, and GG were an iso/hypointense signal on Tl-weighted magnetic resonance images and a signal, the intensity of which varied from heterogeneous to cerebrospinal fluid, on T2-weighted FLAIR images. Cases of DNET and GG displayed no mass effect or perifocal edema, a trend towards location in the temporoinsular regions, and a frequent concurrence with local gray-white matter differentiation disorders and atrophy. The FLAIR images clearly showed the so-called foam-like (multicystic) structure with pericystic changes. No significant change in the dimensions of the identified DNET and GG was observed during the follow up period. In low-grade DA, tumor growth was reduced and it is difficult to differentiate minimal perifocal edema from tumor-like tissue. The sensitivity of these tumors to contrast enhancement is ambiguous. Along with DNET (that was epileptogenic in 100% of cases), DA (91,7%) and GG (80%) were the most common epileptogenic brain tumors.

1. Van Breemen M.S., Wilms E.B., Vecht C.J. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol 2007; 6: 421-430.

2. Roberto G., Alessandro C, Francesco F. et al. Epilepsy associated with supratentorial brain tumors under 3 years of life. Epilepsy Res 2009; 87: 184-189.

3. Алиханов А.А., Генералов В.О., Демушкина А.А., Пере-пелова Е.М., Шимановский Н.Л., Чадаев В.А. Визуализация эпилептогенных поражений головного мозга у детей. М: Видар 2009; 199-219. (Alikhanov A.A., Generalov V.O., Demushkina A.A., Perepelova E.M., Shimanovskiy N.L., Chadaev V.A. Visualization of the epileptogenic damages of a brain in children. Moscow: Vi-dar2009: 199-219.)

4. Barcovich A.J, Kuzniecky R.I., Jackson G.D., Guerrini R., Dobyns W.B. A develop-mental and genetic classification for malformations of cortical development. Neurology 2005; 65: 1873-1887.

5. Van Veelen M.L., Avezaat C.J., Kros J.M. et al. Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatry 1998; 64: 581-587.

6. Корниенко В.Н., Пронин И.Н. Диагностическая нейрора-диология. Атлас. Издательство ИП «АндрееваТ.М.» 2006; 455—599. (Kornienko V.N., Pronin I.N. Diagnostic neurora-diology. Atlas. IP «AndreevaT.M.» 2006; 455-599.)

7. Urbach H. MRI of long-term epilepsy-associated tumors. Se-min Ultrasound CT MRI 2008; 29: 1: 40-46.

8. Luyken C, Blumcke I., Fimmers R. et al. Supratentorial gan-gliogliomas: histopathologic grading and tumor recurrence in 184 patients with a median follow-up of 8 years. Cancer 2004; 101: 146-155.

9. Villarejo F., Alvarez-Sastre C, Martinez-Quinones J. et al. Dysembryoplastic neuroepithelial tumors. Revista de Neurologia 1999; 29: 9: 810-814.

10. FernandezC, GirardN., Paz, ParedesF. etal. The usefulness of MRI in the diagnosis of disembryoplastic neuroepithelial tumor in children: a study of 14 cases. AJNR 2003; 24: 829-834.

11. Stanescu Cosson R., Varlet P., Beuvon F. et al. Disembryoplastic neuroepithelial tumors: CT, MR findings and imaging follow-up: a study of 53 cases. J Neuroradiol 2001; 28: 230-240.

12. Barcovich A.J. Congenital malformations of the brain and skull. In: A.J. Barcovich (ed.). Pediatric neuroimaging 4Th ed. Philadelphia: Lippincott, Williams & Wilkins, 2005; 291-439.

13. Takahashi A., Hong S.C., Seo D.W. et al. Frequent association of cortical dysplasia in dysembryoplastic neuroepithelial tumor treated by epilepsy surgery. Surgical Neurology 2005; 64: 5: 419-427.

14. Provenzflle G.M., Mukundan S., DewhirstM. The role of blood-brain permeability in brain tumors imaging and therapeutics. Am J Roentgenol 2005; 185: 763-767.

15. Aronica E., Leenstra S., van Veelen C.W. et al. Glioneuronal tumors and medically intractable epilepsy: a clinical study with long-term follow-up of seizure outcome after surgery. Epilepsy Res 2001; 43: 179-191.

16. Ogiwara H., Nordli D.R., DiPatriA.J. et al. Pediatric epileptogenic gangliogliomas: seizure outcome and surgical results. J Neurosurg Pediat 2010; 5: 3: 271-276.

17. Selch M. Gangliogliomas: experience with 3 patients and review of the literatute. Am J Clin One 1998; 21: 557-564.

18. MorrisH.H., MatkovicZ, EstesM.L. etal. Ganglioglioma and intractable epilepsy: clinical and neurophysiologic features and predictors of outcome after surgery. Epilepsia 1998; 39: 3: 307—313.