Neurosurgical approaches to pediatric epilepsy: Indications, techniques, and outcomes of common surgical procedures

Abstract

Epilepsy is a common pediatric neurological condition, and approximately one-third of children with epilepsy are refractory to medical management. For these children neurosurgery may be indicated, but operative success is dependent on complete delineation of the epileptogenic zone. In this review, surgical techniques for pediatric epilepsy are considered. First, potentially-curative operations are discussed and broadly divided into resections and disconnections. Then, two palliative approaches to seizure control are reviewed. Finally, future neurosurgical approaches to epilepsy are considered.

Evaluation and outcomes of paediatric epilepsy surgery in Singapore: A single-centre audit

“…30 Corpus callosotomy is beneficial in suitable patients, even if complete seizure freedom rates have been reported to be less than 10-20%. 20,32 We evaluated and selected patients with drop attacks amenable to surgical intervention and 6/9 (67%) achieved freedom from drop attacks, comparable to 55.3% demonstrated in a 2018 metanalysis 33 . At our institution, three corpus callosotomies performed before 2010 were partial, due to reported higher risks of transient disconnection syndrome, mutism.…”

“…Our outcomes were compared to published outcomes in Table 2. 20 Concerns by patients and caregivers of serious postoperative morbidity and mortality are common and often lead to epilepsy surgery delay. However, mortality in childhood DRE is five to nine times higher than the general population.…”

“…Reported seizurefreedom rates varied from 50-85% among paediatric patients. 20 Postoperative hemiparesis and/or homonymous hemianopsia is generally expected. For our hemispherectomy patients, 3/4 (75%) achieved Engel Class IA seizure-freedom.…”

The Efficacy of Nonpharmacologic Treatment in Children with Pharmacoresistant Epilepsy

“…Epilepsi, çocukluk çağında en sık görülen nörolojik bozukluklarından birisi olup beyinde değişik nedenlerle ortaya çıkan anormal elektriksel deşarjlar sonucu oluşan geçici serebral fonksiyon bozukluğudur (1). İki veya daha fazla ateş veya kafa travması gibi uyarıcı bir neden olmaksızın nöbet görülmesi durumunda epilepsi tanısından söz edilir (2).…”

The epileptogenic zone in pediatric epilepsy surgery: Special issue

“…Englot, and Robert P. Naftel discuss the indications, techniques, and outcomes of these common procedures in epileptic children [20]. They also discuss palliative procedures, such as the corpus callosotomy, for the treatment of astatic epilepsy in children.…”