Using preoperative FLAIR signal abnormality to guide extent of resection for management of brain tumor-related epilepsy: 2 Case reports of malignant tumors

Abstract

Background: Brain tumor-related epilepsy is characterized by at least one unprovoked seizure in a patient with a brain tumor confirmed by magnetic resonance imaging (MRI). Seizure outcomes correlate with extent of tumor resection. Accurate preoperative neuroimaging assessment of tumor burden is critical for achieving favorable seizure outcomes following malignant brain tumor resection. Case description: Two cases are presented: one involving a metastasis from lung adenocarcinoma and the other a primary glioma. Both patients presented with seizures and were assessed using T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI sequences. They underwent maximal safe resection based on FLAIR MRI and remained clinically seizure-free after surgery. Conclusions: This report provides radiographic-pathologic correlation to support the practice of using hyperintense regions on preoperative FLAIR sequences to guide the extent of resection in patients with brain tumor-related epilepsy. By incorporating FLAIR abnormalities into preoperative assessment, clinicians may improve seizure control.

Keywords

• Brain tumor
• Epilepsy
• Surgery