Abstract
Gangliocytomas are noteworthy in view of their content of neurons and ganglion cells and their common clinical manifestation include medically intractable epilepsy. It is still debatable whether lesionectomy alone is sufficient for seizure control in treatment of seizures in patient with gangliocytoma. We report a case of gangliocytoma causing epileptic seizures, which was treated successfully by resection of both the tumor and the adjacent epileptogenic cortex. The patient, a 18-year-old man, had suffered from intractable complex partial seizures(once or twice per week)manifested as motionless staring or automatism since the age of 15. A small lesion with a calcified mass was detected in the left parahippocampal gyrus. Intracranial EEG recording with subdural electrodes demonstrated an epileptogenic focus in the fusiform and parahippocampal cortices of the left temporal lobe adjacent to the tumor. The tumor and the adjacent epileptogenic cortex were removed. Before surgery, functional mapping by cortical stimulation was performed. Pathological specimen disclosed gangliocytoma. The patient became seizure-free after surgery and was able to enjoy college life during 2-year follow-up period. This case indicates that patients with benign tumors and intractable epileptic seizures may require additional resection of the adjacent epileptogenic cortical tissue in stead of lesionectomy alone. For presurgical evaluation, both intracranial EEG recording and functional mapping is essential for obtaining a good surgical outcome.
