Surgical management of intractable epilepsy associated with cerebral neurocytoma

Neuronal neoplasms of the CNS constitute a rarely encountered group of tumo rs. This report concerns the surgical management of seizures encountered in four cases (ranging from 2 to 10 years-of-age at onset; consisting of two males and two females) of a recently recognized morphologically unique tumo r, called 'cerebral neurocytoma'. All patients were associated solely with intractable complex partial seizures. The tumor involved the temporal lobe in two cases, and the frontal in two. Magnetoencephalography (MEG) clearly demonstrated an accumulation of equivalent current dipoles originating from the interictal spikes on the cortex around the tumor. On intra-operative e lectrocorticography (ECoG) the epileptogenic zone was topographically disti nct from the region of the tumor. No definite ECoG activities were observed at the tumor site, although this tumor did consist of small mature neurona l cells. Either a complete or a subtotal resection of the tumor and the epi leptogenic cortex was performed and, post-operatively, universal freedom fr om seizures was demonstrated in all patients. A histological examination of the epileptogenic cortex revealed the presence of minute cortical dysplasi a or tumor involvement in the hippocampus. A resection of the epileptogenic cortex along with the tumor was thus found to improve the seizure outcome in patients with neurocytoma-associated epilepsy without inducing any ident ifiable neurological deficits attributable to the incremental resection.