Reoperations and second step-procedures in pediatric epilepsy surgery – indications, new techniques, limitations and results

Winkler, PA; Kudernatsch, Manfred; Pieper, Tom; Kessler-Uberti, S; Staudt, M.; Holthausen, Hans

doi:10.1055/s-0031-1273959

Cited by 1 publication

(3 citation statements)

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“…This rate is similar to the reoperation rate found across other centers, which ranges from 6% to 23%. 2,5,21,26,29,33 In the current study, we found that 58% of children were seizure free (ILAE Class 1) and 75% had a significant reduction of seizures (ILAE Class 1-4) 1 year after reoperation. The number of AEDs remained similar, in accordance with the practice at our institution of maintaining AEDs for at least 2 years following seizure control.…”

Section: Discussionsupporting

confidence: 51%

“…These results are similar to those in previous studies finding that 44%-87% of children attain seizure freedom following reoperation. 2,5,21,26,29,33 Importantly, we found that patients who had not attained seizure control 1 year after reoperation continued to have seizures in future follow-up visits.…”

Section: Discussionmentioning

confidence: 65%

“…zure freedom. 2,5,9,17,21,23,26,29,33 However, this rate of seizure freedom should be considered with caution as the patients who undergo reoperation were judged to be eligible for reoperation and had a good chance of attaining seizure control. Additionally, patient characteristics and surgery type greatly influence outcomes.…”

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confidence: 99%

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Reoperation after failed resective epilepsy surgery in children

Muthaffar

Puka²,

Rubinger

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEAlthough epilepsy surgery is an effective treatment option, at least 20%–40% of patients can continue to experience uncontrolled seizures resulting from incomplete resection of the lesion, epileptogenic zone, or secondary epileptogenesis. Reoperation could eliminate or improve seizures. Authors of this study evaluated outcomes following reoperation in a pediatric population.METHODSA retrospective single-center analysis of all patients who had undergone resective epilepsy surgery in the period from 2001 to 2013 was performed. After excluding children who had repeat hemispherotomy, there were 24 children who had undergone a second surgery and 2 children who had undergone a third surgery. All patients underwent MRI and video electroencephalography (VEEG) and 21 underwent magnetoencephalography (MEG) prior to reoperation.RESULTSThe mean age at the first and second surgery was 7.66 (SD 4.11) and 10.67 (SD 4.02) years, respectively. The time between operations ranged from 0.03 to 9 years. At reoperation, 8 patients underwent extended cortical resection; 8, lobectomy; 5, lesionectomy; and 3, functional hemispherotomy. One year after reoperation, 58% of the children were completely seizure free (International League Against Epilepsy [ILAE] Class 1) and 75% had a reduction in seizures (ILAE Classes 1–4). Patients with MEG clustered dipoles were more likely to be seizure free than to have persistent seizures (71% vs 40%, p = 0.08).CONCLUSIONSReoperation in children with recurrent seizures after the first epilepsy surgery could result in favorable seizure outcomes. Those with residual lesion after the first surgery should undergo complete resection of the lesion to improve seizure outcome. In addition to MRI and VEEG, MEG should be considered as part of the reevaluation prior to reoperation.

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