From the Research
Dysembryoplastic neuroepithelial tumors (DNETs) generally have an excellent prognosis with appropriate management, with complete surgical resection being the primary treatment, often resulting in cure and seizure freedom achieved in 80-90% of patients. The management of DNETs involves a multidisciplinary approach, with surgery, medication, and regular follow-up playing crucial roles.
Key Considerations in DNET Management
- Complete surgical resection is the primary treatment for DNETs, aiming for complete tumor removal while preserving neurological function, especially in eloquent brain areas 1.
- For patients with DNETs presenting with seizures, anti-seizure medications should be continued initially after surgery, with potential tapering after 1-2 years of seizure freedom.
- Regular MRI follow-up is recommended, typically every 6-12 months initially, then annually for several years, to monitor for any signs of recurrence or changes in the brain.
- Radiation therapy and chemotherapy are generally not indicated for DNETs due to their benign nature and excellent response to surgery alone.
Surgical Approach
- The surgical approach should aim for maximal safe resection, utilizing tools such as intraoperative MRI, 5-ALA, and neuronavigation to achieve this goal 2.
- Advances in surgical techniques, including minimally invasive approaches, tubular retractors, endoscopes, and laser interstitial thermal therapy, can improve the safety and efficacy of surgical resection.
Medication Management
- The use of antiepileptic drugs (AEDs) should be tailored to the individual patient, with consideration of the potential for drug-drug interactions and the need for regular monitoring of adverse effects 3.
- The first choice of AED is critical to optimize seizure control and tolerability, considering the effects of the tumor itself.
Prognosis and Quality of Life
- The favorable prognosis of DNETs relates to their slow growth, lack of malignant transformation, and the fact that most neurological symptoms (primarily seizures) can be effectively controlled with surgery and appropriate medication management 1.
- With appropriate management, patients with DNETs can experience significant improvements in quality of life, with seizure freedom and minimal neurological deficits.