A Clinicoradiological Series of 39 Gangliogliomas: Insights into Surgical Outcomes and Prognostic Factors

BACKGROUND AND OBJECTIVES: Gangliogliomas (GGs) are rare, well-differentiated glioneuronal tumors, representing a common cause of neoplastic epilepsy. This study analyzes the presentation, management, and outcomes of a large single-center cohort. METHODS: We retrospectively reviewed 39 patients with histologically confirmed GG. Data on demographics, clinical presentation, imaging, surgical management, and follow-up were analyzed. RESULTS: The mean patient age was 20.8 years. The most common presenting symptom was epilepsy (94.9%, 37/39), with complex partial seizures being predominant. Tumors were predominantly temporal (46.2%, 18/39), followed by cerebellar (15.4%, 6/39) and parietal (12.8%, 5/39) locations. A solid-cystic morphology was the most common radiological pattern (51.3%, 20/39). Gross total resection (GTR) was achieved in 71.8% (28/39) of cases. At a mean follow-up of 7.2 years, 86.5% (32/37) of patients with preoperative epilepsy were seizure-free (Engel Class I). Seizure freedom was significantly associated with GTR ( P < .001). Recurrence/progression was observed in 7 patients (17.9%), strongly associated with anaplastic histology ( P < .001), and subtotal resection ( P = .003). The overall prognosis was excellent for classic GG, with a 100% 10-year survival rate for low-grade tumors. CONCLUSION: GGs have a favorable prognosis after GTR, with excellent rates of seizure control. Tumor recurrence, though rare, is linked to high-grade features and incomplete resection. This series underscores the importance of maximal safe resection as the primary treatment.