Results and Complications after Reoperation for Failed Epilepsy Surgery in Children

Abstract

The seizure outcome and neurological outcome in children who undergo reoperation for failed epilepsy surgery have not been well documented. This retrospective study evaluated 20 children who underwent a second resective surgery for recurrent seizures. Four categories of patients were identified: (1) extension of the initial resection was performed in 8 patients; (2) 5 patients underwent lobectomy or corticectomy in a region remote from the original surgical site; (3) multilobar resection which may have included further resection of the initial procedure was accomplished in 4 patients; (4) hemispherectomy was performed in 3 patients. Patients with reoperation in the same lobe as the first procedure (group 1) had a 62% seizure-free rate, while 44% of patients in groups 2 and 3 were free from seizures at follow-up evaluation. Patients undergoing hemispherectomy had a 67% seizure-free rate. Significant unexpected neurological deficits occurred in 3 patients who underwent multilobar resection at reoperation. Complications included motor and language deficits. Reoperation for intractable partial epilepsy is beneficial in selected children. Patients who require multilobar resections may have higher risk of postoperative neurological deficit than those patients with reoperation in one lobe. These factors may be useful in counseling parents of children considering reoperation for recurrent epilepsy.

Reoperation for Refractory Epilepsy in Childhood

“…Although further resections in the same lobe as the original surgery were reportedly more successful than in remote lobes, 20 this approach led to seizure arrest in only 40% of cases in our cohort. In this subgroup, older age at final surgery (14.2 years for intralobar resections vs 7.6 years for hemispherotomy) entailed declining plasticity for the compensation of potential functional deficit that in turn promoted the delineation of a spatially more limited epileptogenic zone.…”

“…11,12,14 When a false delineation was the main reason of first surgery failure, only 50% of patients were seizure free after reoperation, in line with the overall results of the previous reoperation study that, however, did not explicitly address the reason of first failure as a possible predictor. 20 Interestingly, in this subgroup, patients were finally seizure free after reoperation in 2 of 2 hemispherotomies and multilobar resections, respectively. In contrast, none of the 4 intralobar reoperations achieved the goal of seizure freedom regardless of lobar localization or procedure (lesionectomy, corticectomy, or lobectomy).…”

“…9 The rate of 35% novel permanent neurological deficits after reoperation in our study is, however, higher than the 10% to 15% rates reported in other pediatric epilepsy surgery studies 3,14,19 and in the only previous study explicitly addressing the issue of reoperations. 20 This reflects our strategy of extensive surgery maximizing the chance of seizure freedom with full acceptance of possible neurological deficit. Thus, the occurrence of novel permanent neurological deficits was linked to the resection of eloquent cortex in the context of 61% multilobar or hemispheric procedures in our study.…”

“…Overall, 11 (55%) patients became seizure free and the authors underlined the higher rate of seizure freedom and lower rate of neurological deficit in patients operated on within the same lobe as the initial surgery. 20 This cohort included 7 of 21 nonlesional patients with reoperations driven by intracranial electroencephalography (EEG) in 12 of 21 cases.…”

Hemispherectomy in the treatment of pediatric symptomatic epilepsy of children

“…В некоторых сериях опи-сываются больные, которых оперировали повторно из-за продолжающихся припадков с хорошим исхо-дом [21]. Обсуждается также роль коры островка в эпилептогенезе [22].…”