Electrocorticographic–Histopathologic Correlations Implying Epileptogenicity of Dysembryoplastic Neuroepithelial Tumor

Kota KAGAWA; Koji IIDA; Akiyoshi KAKITA; Masaya KATAGIRI; Takeshi NISHIMOTO; Akira HASHIZUME; Yoshihiro KIURA; Ryosuke HANAYA; Kazuhiko SUGIYAMA; Koji ARIHIRO; Kazunori ARITA; Kaoru KURISU

doi:10.2176/nmc.oa2012-0420

Original Articles

Electrocorticographic–Histopathologic Correlations Implying Epileptogenicity of Dysembryoplastic Neuroepithelial Tumor

Kota KAGAWA, Koji IIDA, Akiyoshi KAKITA, Masaya KATAGIRI, Takeshi NISHIMOTO, Akira HASHIZUME, Yoshihiro KIURA, Ryosuke HANAYA, Kazuhiko SUGIYAMA, Koji ARIHIRO, Kazunori ARITA, Kaoru KURISU

Author information

Kota KAGAWA
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
Koji IIDA
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
Akiyoshi KAKITA
Department of Pathology, Brain Research Institute, University of Niigata
Masaya KATAGIRI
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
Takeshi NISHIMOTO
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
Akira HASHIZUME
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
Yoshihiro KIURA
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
Ryosuke HANAYA
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
Kazuhiko SUGIYAMA
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
Koji ARIHIRO
Department of Pathology, Graduate School of Biomedical Sciences, Hiroshima University
Kazunori ARITA
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
Kaoru KURISU
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University

Keywords: dysembryoplastic neuroepithelial tumor (DNT), epileptogenicity, epilepsy surgery, intracranial electroencephalography (EEG), histopathology

JOURNAL OPEN ACCESS

2013 Volume 53 Issue 10 Pages 676-687

DOI https://doi.org/10.2176/nmc.oa2012-0420

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Abstract

Based on intracranial-video electroencephalography (EEG), histopathological features, and postoperative seizure outcome, we elucidated the epileptogenicity in patients with dysembryoplastic neuroepithelial tumor (DNT). Five patients (P1–P5) pathologically diagnosed with DNT underwent intracranial-video EEG to identify the ictal onset zone and irritative zone. We evaluated the correlations of ictal onset zone and irritative zone with the magnetic resonance imaging-visible lesion (MRI-lesion) and their histopathological features. Intracranial-video EEG located the ictal onset zone adjacent to the MRI-lesion margin in four patients with complex/simple forms of DNT subcategory, and on the MRI-lesion in P3 with a nonspecific DNT form. The irritative zone extended to surrounding regions of the ictal onset zone in all patients. Histopathologically, MRI-lesions were characterized by specific glioneuronal elements, whereas the ictal onset zone and irritative zone were represented with dysplastic cortex accompanying oligodendroglia-like cells in four (P1, P2, P4, and P5) of five patients. Cortical dysplasia was identified with typical histopathologic features in the irritative zone remote from the MRI-lesion in P5. P3, with a nonspecific form, indicated prominent component of dysplastic cortex with oligodendroglia-like cells scattered in the MRI-lesion. Lesionectomy of MRI-lesion with additional cortical resections (including the ictal onset zone and irritative zone) yielded postoperative seizure freedom (Engel Class I) in P3, P4, and P5, while P1 and P2 (with only lesionectomy) experienced postoperative residual seizure (Class II and III in each patient). Our results suggest the intrinsic epileptogenicity of DNT. The topographical correlation indicated that the dysplastic cortex accompanying oligodendroglia-like cells was more epileptogenic than the specific glioneuronal elements itself. Meticulous intracranial-video EEG analysis delineating the MRI nonvisible ictal onset zone and the irritative zone may yield better seizure outcome.

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