Excessive pursuit of total resection is unnecessary for postoperative seizure control in oligodendroglioma

Objective: Molecular subtypes in glioma diagnosis are gradually highlighted and thought to affect preoperative seizure occurrence. ​However, whether molecular subtypes affect postoperative seizure freedom is still unknown. Moreover, whether chromosome 1p/19q co-deletion is a risk factor for postoperative seizures that lack evidence to verify. Methods: This single-center retrospective study (including 1075 patients with primary adult-type glioma) included data from the Chinese Glioma Genome Atlas. The follow-up information on postoperative seizure control after 12 months in post-operation was collected. Binary logistic regression was applied to identify independent factors for postoperative seizure freedom based on different molecular subtypes and history of preoperative glioma-related epilepsy (GRE). Moreover, the optimal extent of tumor resection (EOR) for postoperative seizure control was evaluated by receiver operating characteristic curve and binary logistic analysis. Results: Chromosome 1p/19q co-deletion (OR: 1.555; 95%CI: 1.032–2.343; p=0.035) was independent risk for postoperative seizure freedom in patients with IDH mutation. Moreover, history of preoperative GRE (OR: 6.027; 95%CI: 3.661–9.922; p<0.001) and invasion of the temporal lobe (OR: 2.347; 95%CI: 1.430–3.853; p=0.001) were independent risks for postoperative seizure freedom in patients with IDH wild-type. Patients with oligodendroglioma and preoperative GRE had good seizure control when the EOR was ≥ 0.90 but similar as EOR was equal to 1.00. Conclusions: Chromosome 1p/19q co-deletion was only useful for patients with IDH mutation to predict bad postoperative seizure control. If without preoperative GRE, higher EOR did not contribute to postoperative seizure freedom; and if with, not pursuing total resection was only recommended in patients with oligodendroglioma.