Recent studies have found that in the cerebral hemisphere, slow-growing tumors (e.g., low-grade gliomas or meningiomas) are more likely to cause seizures than rapidly growing tumors (e.g., glioblastomas), especially those low-grade gliomas in which the main body of the tumor is located in the cerebral cortex, and patients often have epilepsy as their first symptom [1]. Currently, surgery is still the main treatment for patients with tumorigenic epilepsy, and there are many factors affecting the prognosis of epilepsy before and after surgery, which are reviewed in this paper as follows. 1. preoperative factors 1.1 Epilepsy-related factors 1.1.1 Age of onset and duration of disease: It is generally believed that the earlier the onset of epilepsy in adult patients with low-grade glioma, the better the prognosis. burger et al [2] concluded that among all the factors affecting the prognosis of patients with low-grade glioma, age is the most important factor, and age >40 years has a poorer prognosis than age ≤40 years, as evidenced by shorter survival time and poorer seizure control. The prognosis of patients aged >40 years is worse than that of those aged ≤40 years. In addition, the shorter the duration of epilepsy, the earlier the detection of the tumor and surgical treatment, the better the prognosis of epilepsy. chang et al [3] found that those with preoperative epilepsy duration >1 year had difficulty controlling epilepsy after surgery. However, Zhou Yanhong et al [4] concluded that there was no significant correlation between the length of epilepsy and prognosis. 1.1.2 Seizure type and frequency: Studies have shown that: single seizure forms have a better prognosis than multiple seizure forms; generalized tonic-clonic seizures and simple aphasic seizures have a better prognosis; complex partial seizures have a worse prognosis, as shown by the tendency to recur after postoperative drug withdrawal; partial seizures are more likely to recur than generalized seizures, the reasons for which are not yet known [3]. In the UK, Shorvon [5] followed 792 patients in early seizures for a mean of 7.2 years and showed that: the frequency of seizures within six months of first onset was the most important predictor of remission, and patients with only 2 seizures within six months had a 95% probability of achieving 1-year remission and 47% probability of 5-year remission within 6 years of diagnosis; while those with ≥ 10 seizures within 6 months, the 1-year and 5-year remission rates were 75% and 24%, respectively. The results may provide a reference for the assessment of seizure frequency before and after surgery in patients with low-grade gliomas. 1.1.3 Drug control: Some patients with low-grade glioma were taking antiepileptic drugs (AEDs) after seizure onset. The prognosis of the former is significantly better than that of the latter. 1.1.4 EEG performance: Many studies have shown that EEG showing bilateral synchronous discharges has a better prognosis than those with abnormalities in one hemisphere, diffuse abnormalities or focal abnormalities; EEG showing focal spikes localized in the parietal, occipital, central, middle or anterior temporal lobes has a better prognosis, while those in the frontal and posterior temporal lobes have a worse prognosis than the former. Those whose basic EEG waveform is slow wave have an increased risk of poor prognosis; those who exhibit high-amplitude dysrhythmias, diffuse or multifocal pathological seizure waves, and no significant improvement with treatment, mostly have a poor prognosis. Foreign studies have reported [6-7] that the localization of epileptogenic foci by EEG and the foci of CT, MRI and other imaging are in the range of 60%-80%, and the higher the rate of compliance between the two, the better the control of epilepsy after surgical resection of the tumor. 1.2 Tumor-related factors 1.2.1 Imaging performance: ①Tumor location: Since the frontal and temporal lobes have the anatomical characteristics of nerve fiber conduction and blood circulation in the corresponding areas, patients with low-grade glioma in the frontal and temporal lobes have a higher incidence of epilepsy, and their prognosis of epilepsy after tumor removal is not as good as that of patients in the parieto-occipital lobe, especially when the tumor is located in the temporal lobe, the hippocampus, amygdala and other limbic system structures are often involved. The tumor is located in the temporal lobe and the hippocampus, amygdala and other limbic system structures are often involved, resulting in a higher recurrence of epilepsy after surgery. Rossi et al [8] found that tumor size has a significant impact on the prognosis of epilepsy, and patients with tumor diameter >4 cm have poorer postoperative seizure control than those with tumor diameter ≤4 cm. (3) Occupancy effect of the tumor, the extent of edema, the presence of enhancement and cystic changes: these characteristics are factors reflecting the growth characteristics and invasiveness of the tumor, and they may reduce local cerebral perfusion pressure, vascularization and impaired microcirculation, with ischemic changes and metabolic disorders, which in turn induce the formation of epileptogenic foci in a certain range and ultimately affect the surgical efficacy and epilepsy prognosis. However, there is a lack of definitive reports from home and abroad demonstrating the impact of these factors on the prognosis of epilepsy. 1.2.2 Pathological types: Low-grade gliomas are clinically defined as astrocytomas, oligodendrogliomas and oligodendro-astrocytomas with Kernohan grade I and II or WHO grade I and II. Schramm et al [9] suggested through a recent study that there is a new subtype of astrocytoma with a long history of epilepsy that presents a benign clinical prognosis and a pathology of well-differentiated astrocytic infiltrates with a low density of tumor cells, no nucleolytic phase, an immunohistochemical MIB-1 proliferation index <1 1%, P53 (-), glial cell CD34 and MAP2 (-); the authors concluded that the grading should be WHO grade I. However, whether this can indicate that the lower the grade of glioma, the better the prognosis, remains to be studied in depth. 2. Intraoperative factors 2.1 The extent of tumor resection Clinical practice has proved that only complete resection of the organic lesion cannot completely eliminate epileptic discharges, and the elimination rate of epileptic discharges can only be improved by expanding the resection of some brain tissues around the lesion, especially the white matter of the brain. Zhou Yanhong et al [10] found that there was a significant relationship between the degree of tumor resection and the prognosis of epilepsy, and the postoperative epilepsy disappearance rate was significantly greater in patients with complete tumor resection (82.3%) than in those with incomplete tumor resection (including near-total and subtotal resection, 55.5%); this is consistent with the findings of Chang et al [3]. 2.2 Cortical EEG monitoring and surgical approach Luan et al [11] treated 600 patients with simple low-power electrocoagulation and thermal cautery or combined with resection of epileptogenic foci, and the results showed that the percentage of Engel grade I after simple electrocoagulation and thermal cautery was about 50%, and the efficiency rate (Engel grade I and II) was about 75%, while the total efficiency of electrocoagulation and thermal cautery combined with resection of epileptogenic foci was about 90%. The total efficiency of electrocoagulation and thermal cautery combined with epileptogenic foci resection was about 90%. In their study, Yanhong Zhou et al [10] showed that resection of tumor lesions followed by multiple subxiphoid transection (MST) of the cortex with spikes improved the prognosis of patients with epilepsy more than resection of lesions alone (P = 0.021). In a study by Yunlin Liu et al [12], different surgical approaches (including resection of epileptogenic foci, MST, selective corpus callosotomy, temporal pole resection, etc.) were used according to the preoperative EEG and intraoperative cortical EEG performance, and patients showed significant improvement in EEG (P < 0.01) and disappearance or significant reduction in seizures at 1 week and 5 years postoperative follow-up compared with preoperative. It can be seen that selective epilepsy surgical treatment based on intraoperative ECoG performance after tumor resection in patients with low-grade glioma can help improve the prognosis of epilepsy. 3, Postoperative factors 3.1 Postoperative complications 3.1.1 Intracranial infections: Cases of intracranial infections causing epilepsy are not uncommon in the field of neurosurgery, and their mechanisms are widely discussed. However, in any case, it is beneficial and not harmful for the patient's prognosis of epilepsy for the clinician to minimize the risk of infection in the perioperative period. 3.1.2 Intracranial hemorrhage: This includes subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hemorrhage, and is mostly associated with inadvertent intraoperative manipulation or lax hemostasis. Any form of bleeding has the potential to trigger seizures, and the literature reports that subcortical hemorrhage leading to interictal epilepsy is more common [13]. Intracranial hemorrhage, one of the complications of glioma surgery, often has a poor prognosis when it leads to persistent status epilepticus [14]. Therefore, rigorous intraoperative operation and close postoperative observation of the condition, timely detection and timely management are necessary to prevent the occurrence of postoperative epilepsy. 3.1.3 Cerebral edema and high cranial pressure: they can aggravate cerebral hypoxia, which can lead to abnormal neuronal cell discharge and cause epilepsy. Therefore, postoperative active treatment of cerebral edema and reduction of cranial hypertension are beneficial to reduce seizures. 3.2 Postoperative use of AEDs AEDs have a significant impact on the short-term prognosis of epilepsy.Datta et al [15] reported that about 70%-80% of seizures can be controlled by timely and regular administration of AEDs, and the remission rate of monotherapy is about 70%, while the remission rate of polypharmacy can only increase by 6.0%. Many domestic studies have also shown that the rate of complete control of epilepsy and the total effective rate in patients receiving formal drug therapy are significantly greater than those treated informally and those who did not receive treatment. Shih, Paulin et al [16] concluded that poor first-time control of epilepsy with a single drug is a risk factor for prognosis. Although most of the above conclusions are summarized from the effect of drug control in primary epilepsy, the effect of correct postoperative use of AED in patients with low-grade glioma can be used as a reference. 3.3 Postoperative radiotherapy Jenrow et al [17] concluded that low-dose X-ray radiation can suppress seizures without serious complications, and Kortmann et al [18] noted that the effective seizure control rate after radiotherapy in patients with low-grade glioma was 80%; Ruda et al [19] studied 25 patients with low-grade glioma presenting with refractory epilepsy and found that after postoperative radiotherapy, 19 of them had a higher seizure rate. Ruda et al [19] studied 25 patients with low-grade glioma presenting as refractory epilepsy and found that postoperative radiotherapy reduced seizures by more than 50% in 19 of them compared to the preoperative period. In a study by the European Organization for Research on Cancer Therapy (EORTC22845) [20], the remission rate of epilepsy at 1 year was lower in the postoperative radiotherapy group than in the observation group (25% vs. 41%). Clinical studies on the effectiveness of immediate postoperative radiotherapy in reducing seizures in patients are underway by the author. 3.4 Gene therapy has been shown to be more sensitive to chemotherapy in patients with oligodendroglial cell tumors with heterozygous deletions of chromosomes 1p and 19q. There are few reports on gene therapy for the control of epilepsy. If tumor-induced "epileptogenic genes" can be identified, gene therapy drugs may also be a new approach to treat epilepsy. At present, various imaging methods such as single photon emission tomography (SPECT), positron emission tomography (PET), magnetic resonance spectroscopy (MRS), magnetoencephalography (MEG), etc. can assess the cerebral blood perfusion, cerebral glucose metabolism, cerebral oxygen consumption and energy metabolism, cerebral neuronal electrical activity, etc., to evaluate the interstitial foci of epilepsy. In turn, they can guide epilepsy surgery and thus maximize the prognosis of epilepsy. However, these tests cannot be widely performed due to various factors. It is hoped that these advanced technologies will be popularized in the near future, bringing good news to the majority of epilepsy patients.