Surgical Treatment of Refractory Epilepsy

The extension of cortical resection to treat children with intractable epilepsy is one of the most exciting advances in pediatric neurology in the past two decades. Many children with epilepsy who previously had little hope have been given a new chance at life. Many patients who were not considered for surgery are now recognized to be excellent surgical candidates. Most notably, children with generalized seizures such as infantile spasms or gelastic seizures caused by hypothalamic hamartomas now have the opportunity to benefit from surgery. In adults, there is one goal for epilepsy surgery: freedom from seizures. This is an important goal but it is not the only one in children. It may not even be the most important goal. When operating on young children with epilepsy, we seek to alter the long-term developmental and behavioral outcome. Although there are many significant recent advances in pediatric epilepsy surgery, three are particularly important. These are 1) hemispherotomy for children who require hemispheric resection; 2) resection of hypothalamic hamartomas through an innovative transcallosal approach; and 3) resection of multiple tubers in children with tuberous sclerosis complex.