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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2020.tde-13022020-104136
Document
Author
Full name
Romes Andre Proença de Souza
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Sakamoto, Américo Ceiki (President)
Carlotti Junior, Carlos Gilberto
Centeno, Ricardo Silva
Fernandes, Regina Maria Franca
Title in Portuguese
Tumores associados à epilepsia
Keywords in Portuguese
Cirurgia de epilepsia
Epilepsia relacionada a tumor de longa duração
Gliomas de baixo grau
Tumor neuroepitelial desembrioblastico
Abstract in Portuguese
Introdução: A Epilepsia é uma doença crônica de ocorrência mundial, com prevalência próxima de 80 milhões de pessoas. Acima de dois terços estão entre os indivíduos de média e baixa renda. As lesões estruturais estão entre as principais causas de epilepsia refratária. Entre as lesões estruturais associadas a epilepsia, os tumores são a segunda etiologia que necessitam de cirurgia em diversos centros. Entre os tumores associados a epilepsia, os tumores de baixo grau têm um potencial epileptogênico maior em relação aos de alto grau. O tumor disembrioplásico neuroepitelial (DNT) e o ganglioglioma correspondem aos principais tumores encontrados em diversas séries. Objetivo: Avaliar o desfecho cirúrgico de pacientes submetidos a cirurgia de epilepsia por tumor encefálico. Materiais e métodos: Uma amostra de oitenta e seis pacientes submetidos a cirurgia de epilepsia foram selecionados, entre 0 e 60 anos, que foram submetidos a avaliação pré-operatória com VEEG, e o resultado histopatológico foi tumor. Resultados: Trinta e oito pacientes apresentavam idade a partir de 19 anos, quarenta e oito pacientes apresentavam idade abaixo de 19 anos. O tipo histológico de maior prevalência foi o DNT, com 37,2% seguido pelo ganglioglioma com 22,1%. O principal sítio de acometimento foi o lobo temporal, respondendo por 66,3% da série. A taxa de pacientes classificados como Engel I foi de 77,9% no primeiro ano e 74% no quinto ano de acompanhamento. Atividade de base normal no EEG, a concordância semiológica e a concordância do EEG ictal foram associadas ao melhor resultado. A utilização de EEG invasivo não alterou o prognóstico. Na análise multivariada entre as variáveis EEG ictal, EEG interictal, semiologia e atividade de base, a última normal associou-se ao desfecho Engel I (p=0,012). A lesionectomia isolada foi associada à pior resultado no controle das crises. Conclusão: Os dados de VEEG apresentam um importante valor preditivo na avaliação pré-cirúrgica. Cirurgia em lobo temporal, lesionectomia ampliada e lobectomia foram associadas à melhor desfecho cirúrgico
Title in English
Epilepsy-associated tumors
Keywords in English
"Long-term epilepsy-associated tumor
Dysembryoplastic neuroepithelial tumor
Epilepsy surgery
Low grade gliomas
Abstract in English
Introduction: Epilepsy is a chronic disease and affects up to 80 million people worldwide. About two-thirds of these patients are in middle and low-income. Refractory epilepsy can occur in 20 to 30% of patients. Structural brain lesions are the principal cause of refractory epilepsy. In particular, brain tumors are the second etiology that requires surgery in specialized epilepsy centers. Furthermore, low-grade tumors have a higher epileptogenic potential compared to those of high-grade tumors associated with epilepsy. The dysembryoplastic neuroepithelial tumor (DNT) and ganglioglioma correspond to the foremost found in clinical cohorts. Objective: Evaluate the surgical outcome in patients undergoing epilepsy surgery by brain tumors. Materials and methods: A sample of 86 patients undergoing epilepsy surgery were selected, between 0 and 60 years old, who underwent preoperative evaluation with Video-EEG, and the histopathologic result was tumor. Results: 38 patients were aged from 19 years old; 48 patients were aged below 19 years old. The most prevalent histological type was DNT with 37.2% followed by ganglioglioma with 22.1%. The main site of involvement was the temporal lobe, accounting for 66.3% of all series. The rate of patients classified as Engel I was 77.9% in the first year and 74% in the fifth year of follow-up. Normal EEG-based activity, Semiologic concordance and ictal EEG concordance were associated with the best result. The use of invasive EEG did not alter the prognosis. In the multivariate analysis between the variable ictal EEG, Interictal EEG, semiology and backgroud activity, the last normal was associated with favorable outcome (p = 0.012). Isolated lesionectomy was associated with worse results in seizure control. Conclusion: The electroencephalographic data present an important predictive value in the presurgical evaluation. A broader surgery (enlarged lesionectomy) or lobectomy was associated with better outcome, as well as the presence of temporal surgery presented a better outcome in relationship to non-temporal surgeries
 
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Publishing Date
2020-03-17
 
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