Surgery for catastrophic epilepsy in infants 6 months of age and younger

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Few data are available concerning efficacy and safety of surgery for catastrophic epilepsy in the first 6 months of life.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors retrospectively analyzed epilepsy surgeries in 15 infants ranging in age from 1.5 to 6 months (median 4 months) and weight from 4 to 10 kg (median 7 kg) who underwent anatomical (4 patients) or functional (7 patients) hemispherectomy, or frontal (1 patient), frontoparietal (2 patients), or parietooccipital (1 patient) resection for life-threatening catastrophic epilepsy due to malformation of cortical development.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>No patient died. Intraoperative complications included an acute ischemic infarction with hemiparesis in our youngest, smallest infant. The most frequent complication was blood loss requiring transfusion, which was encountered in every case. The estimated blood loss was 3–214% (median 63%) of the total blood volume. At maximum follow-up of 6–121 months (median 60 months), 46% were seizure free.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Epilepsy surgery may be effective in young infants as it is in older children. However, intraoperative blood loss and risk of permanent postoperative neurological deficits present significant challenges.</jats:p></jats:sec>

Surgery for infants with catastrophic epilepsy: an analysis of complications and efficacy

“…Previously reported series in children less than 3 years old show Engel Sixty-four percent of the children in our series underwent hemispherotomy as their initial procedure. Previous studies in children less than 1 have reported hemispherotomy rates ranging from 64 to 73 % [25,11,14]. This is a slightly higher rate of hemispherotomy than that reported in children under the age of 3 years old [7,9,[22][23][24][25].…”

“…All of our patients required transfusion, and one required staging of surgery due to excessive blood loss. This universal need for blood transfusion has been shown in other series of infants less than 1 year of age undergoing epilepsy surgery [14]. The frequent need for large transfusion volumes and the length of the operation leads to the potential for large fluid shifts from the intravascular space.…”

“…Forty-six (40 %) of these patients had surgery at less than 1 year of age. Gowda et al reviewed a series of 15 infants under the age of 6 months who underwent seizure surgery for catastrophic epilepsy [14]. Forty-six percent of the children were seizure-free at time of last follow-up.…”

“…The small blood volume, delicate physiology, friable brain parenchyma, and often aberrant brain anatomy raise unique surgical and anesthetic risks. Historically, there has been reluctance to intervene; however, the surgical approaches established for treatment of children with epilepsy are increasingly being applied to infants [14].…”

Functional hemispherectomy for catastrophic epilepsy in very young infants: technical considerations and complication avoidance

“…For the same reasons, intraoperative hemostasis is difficult to achieve causing additional discomfort for the surgeon and risk to the patient. Also, ischemic strokes in very young infants that underwent brain surgery have been reported [9].…”