Seizure and insular gliomas

Background: Insular gliomas are complex and present a great challenge as far as their management is concerned. Most insular gliomas present with seizures and control of seizures is an important goal of treatment. The aim of this paper was to highlight the different seizure semiologies presented by insular glioma and their short term outcome to the treatment.

Methods: 13 patients (Mean age 36 years, M:F = 9:4) with insular gliomas presenting with seizures were analyzed for clinical presentation, radiological features, treatments received and seizure outcome (Engel's grade).

Results: Complex partial seizures (n = 8) was the most common semiology with olfactory aura found in 5 of them. Left sided lesions were encountered in 7 patients while 6 patients had right-sided lesions. 7 patients had non-enhancing lesions, 5 patients showed patchy enhancement while 1 patient had strong however heterogenous enhancement of the tumor. 8 patients had tumour in insula with nearly equal extension into frontal and temporal operculum while remaining five patients had tumor in insula with extension in to one of the two lobes. 9 patients underwent subtotal excision as against 4 patients with near total excision. Postoperative complication included hemiplegia in one and speech abnormalities in two patients. Most common histology was grade 2 astrocytomas (n = 5) followed by grade 2 ologodendrogliomas (n = 3). At a mean follow-up of 10.7 months, 11 patients had Engel 1 seizure control, 1 had Engel 2 control while persistent seizures (Engel 4) was present in only one patient.

Conclusion: Insular gliomas present with complex partial seizures with olfactory aura. Majority of the gliomas are WHO grade 2 astrocytomas and oligodendrogliomas. Judicious surgery combined with adjuvant therapy may provide excellent seizure control with acceptable morbidity.