Postsurgical Seizure Outcome for Epilepsy Patients According to Histopathological Diagnosis: A Single-Center Experience

Purpose: This study aimed to further explore the association between histopathology of the epileptogenic zone and postsurgical seizure outcome in epilepsy patients, with a specific focus on dual or multiple pathologies. Patients and Methods: In this single-center retrospective cohort study, 449 patients who underwent epilepsy surgery between 2017 and 2024 at The First Affiliated Hospital of Fujian Medical University were included. Clinical data were collected, including histopathological diagnoses and seizure outcome at ≥12 months postoperatively. We investigated the association of histopathology, epilepsy duration, the number of preoperative antiseizure medications (ASMs), and MRI findings with seizure outcome, using logistic regression analysis. Results: Among 449 patients, the most common histopathological diagnoses were low-grade epilepsy associated neuroepithelial tumors (LEAT, 34.3%) and cerebral vascular malformations (24.5%). Of 382 patients with complete follow-up data, 76.4% achieved seizure freedom (Engel I), with a median follow-up of 47 months. Patients with LEAT had the highest seizure-free rate (88.4%), whereas worse seizure outcome was observed in patients with focal cortical dysplasia (FCD) and gliosis, with 59.2% and 58.8% remaining free from disabling seizure, respectively. Multivariate logistic regression analysis identified FCD (OR = 4.290), gliosis (OR = 4.359), and dual or multiple pathologies (OR = 3.558) as independent predictors of seizure recurrence. Longer epilepsy duration (OR = 1.005) and a greater number of preoperative ASMs (OR = 1.235) were associated with an unfavorable prognosis. Preoperative MRI results are not an independent predictor of postoperative seizure recurrence in epilepsy patients. Conclusion: Histopathological diagnosis, shorter epilepsy duration, and fewer preoperative ASMs predicted favorable surgical outcome in epilepsy patients. In contrast, dual/multiple pathologies, FCD, and gliosis carried an increased risk of postoperative seizure recurrence. These results highlight the importance of early surgical intervention, detailed histopathological assessment, and precise localization of the epileptogenic zone to improve outcome.