Greater extent of resection improves ganglioglioma recurrence-free survival in children: A volumetric analysis

BACKGROUND: Gangliogliomas are rare, low-grade, glial-neural tumors that are most often found in children. They can recur with varying frequency; yet few data are available that adequately predict such events. OBJECTIVE: To review our institution's large series of gangliogliomas in children and identify clinical features that predict recurrence-free survival. METHODS: Clinical records were retrospectively reviewed from 1990 to 2011. Fifty-three children were identified, and pertinent clinical features were analyzed against survival data to categorize lesions at high risk of recurrence. RESULTS: Fifteen children (28%) experienced a recurrence during the study period with a median time to recurrence of 8.8 months and a mean follow-up of 4.2 years. The 5-year recurrence-free survival rate was 70.5%, whereas the overall survival rate was 98.1%. Older age at diagnosis (P =.02), seizure history (P <.001), supratentorial tumor location (P <.001), and greater extent of surgical resection (P <.001) were all associated with improved recurrence-free survival on univariate analysis. Extent of surgical resection was the only clinical variable that retained its significance in multivariate models (P =.01). Patients who received 94% or greater volumetric extent of resection had prolonged recurrence-free survival compared with those individuals who received a less than 94% resection (P =.02). CONCLUSION: Attention to specific clinical variables, most notably the extent of surgical resection, can further stratify grade I gangliogliomas into low-and high-risk groups among children. Although 100% resection should remain an operative goal for surgically accessible gangliogliomas, a thorough yet subtotal resection may improve recurrence-free survival.