Predictors of postoperative seizure outcome in low grade glioma: From volumetric analysis to molecular stratification

Tamara Ius, Giada Pauletto, Barbara Tomasino, Marta Maieron, Riccardo Budai, Miriam Isola, Daniela Cesselli, Christian Lettieri, Miran Skrap

Research output: Contribution to journalArticlepeer-review


The importance of the extent of resection (EOR) has been widely demonstrated as the main predictor for survival, nevertheless its effect on tumor related epilepsy is less investigated. A total of 155 patients were enrolled after a first-line surgery for supratentorial Diffuse Low Grade Gliomas (DLGGs). Postoperative seizure outcome was analyzed stratifying the results by tumor volumetric data and molecular markers according to 2016 WHO classification. Receiver operating characteristic (ROC) curves were computed to asses EOR, residual tumor volume, and ∆T2T1 MRI index (expressing the tumor growing pattern) corresponding to optimal seizure outcome. A total of 70.97% of patients were seizure-free 18 months after surgery. Better seizure outcome was observed in IDH1/2 mutated and 1p/19q codeleted subgroup. At multivariate analysis, age (p = 0.014), EOR (p = 0.030), ∆T2T1 MRI index (p = 0.016) resulted as independent predictors of postoperative seizure control. Optimal parameters to improve postoperative seizure outcome were EOR ≥ 85%, ∆T2T1 MRI index ≤ 18 cm3, residual tumor volume ≤ 15 cm3. This study confirms the role of EOR and tumor growing pattern on postoperative seizure outcome independently from the molecular class. Higher ∆T2T1 MRI index, representing the infiltrative component of the tumor, is associated with worse seizure outcome and strengthens the evidence of common pathogenic mechanisms underlying tumor growth and postoperative seizure outcome.

Original languageEnglish
Article number397
Number of pages19
Issue number2
Publication statusPublished - Feb 2020


  • Extent of resection
  • Low grade glioma
  • Molecular markers
  • ROC curves
  • Seizure outcome
  • Tumor growth pattern

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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