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Epilepsy surgery has become a treatment option for children with medically intractable epilepsy [1][2][3][4][5][6] . Accurate localization and removal of the epileptogenic zone is crucial in order to achieve seizure control. most centers like ours reserve intracranial recording for complex cases, such as those with potential multiple foci or dual pathology, or to resolve discordant data in which surface electroencephalogram (EEG) and magnetic resonance imaging (mRi) do not provide enough information to correctly recognize the ictal onset zone.the goal of the surgery is to accurately identify and remove the epileptogenic zone while minimizing new functional deficits from surgery. our main objective though remains the attainment of complete seizure freedom without harm to the patient.intracranial recording includes epidural pegs, subdural grid placement, and depth electrode insertion. in the past, like most pediatric epilepsy centers we have implanted large subdural grids in patients with epilepsy in order to further map the ABSTRACT: Background: the surgical removal of the epileptogenic zone in medically intractable seizures depends on accurate localization to minimize the neurological sequelae and prevent future seizures. to date, few studies have demonstrated the use of depth electrodes in a pediatric epilepsy population. Here, we report our study of pediatric epilepsy patients at our epilepsy center who were successfully operated for medically intractable seizures following the use of intracranial depth electrodes. in addition, we detail three individuals with distinct clinical scenarios in which depth electrodes were helpful and describe our technical approach to implantation and surgery. Methods: We retrospectively reviewed 18 pediatric epilepsy patients requiring depth electrode studies who presented at the University of Alberta Comprehensive Epilepsy Program between 1999 and 2010 with medically intractable epilepsy. Patients underwent cortical resection following depth electrode placement according to the Comprehensive Epilepsy Program surgical protocols after failure of surface electroencephalogram and magnetic resonance imaging to localize ictal onset zone. Result: the ictal onset zone was successfully identified in all 18 patients. treatment of all surgical patients resulted in successful seizure freedom (Engel class i ) without neurological complications. Conclusion: intracranial depth electrode use is safe and able to provide sufficient information for the identification of the epileptogenic zone in pediatric epilepsy patients previously not considered for epilepsy surgery.RÉSUMÉ: Électrodes profondes dans la chirurgie de l'épilepsie en pédiatrie. Contexte : l'ablation chirurgicale de la zone épileptogène chez les patients atteints de crises d'épilepsie réfractaires au traitement médical dépend d'une localisation précise du foyer épileptogène afin de minimiser les séquelles neurologiques et de prévenir les crises. À ce jour, peu d'études ont démontré l'utilité d'électrodes profondes chez une populatio...

Introduction: Neurovascular lesions are rare and understudied in the pediatric population. Their initial presentation can range from seizures to focal neurologic deficits, as well as headaches. The goal of this study was to examine the clinical presentation and natural history of neurovascular lesions in children with epilepsy. Methods: We reviewed all pediatric epilepsy patients with neurovascular lesions diagnosed between 2006 and 2018 at the University of Alberta and the Stollery Children’s Hospital, Edmonton, Canada. Initial clinical presentation and brain imaging, as well as long-term epilepsy and postsurgical outcome, were assessed. Results: Of the 14 patients, 10 patients had an initial presentation of focal seizures with impaired awareness, whereas 2 patients presented with headache, 1 presented with visual field defects as well as chronic headaches, and 1 with decreased level of consciousness. Seven patients had cavernous angiomas, 6 had arteriovenous malformation, and 1 patient had an arteriovenous fistula. Notably, all patients with cavernous angiomas and 4 of 6 patients with arteriovenous malformations presented with seizures. Among 9 of the 14 who underwent neurovascular corrective surgery, all 9 patients required long-term antiepileptic treatment of at least 1 antiepileptic drug for seizure control after the operation. Conclusion: In this novel case series, we describe focal seizures as the initial presentation of pediatric neurovascular lesions. This clinical presentation appears to be independent of the type of neurovascular lesion. Furthermore, unlike our pediatric surgical patients with epilepsy due to other causes, seizure freedom following neurovascular surgery is limited, and patients require long-term antiepileptic treatment.

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