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Resective surgery for intractable epilepsy in children: radiologic evaluation.
R B Dietrich1, S el Saden, H T Chugani
1Department of Radiological Sciences, University of California, Los Angeles 90024.
AJNR. American Journal of Neuroradiology
|November 1, 1991
Summary
Epilepsy surgery, particularly hemispherectomy, is effective for children with intractable seizures and brain lesions. Postoperative imaging is crucial for detecting complications early, guiding treatment, and improving outcomes.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Neurosurgery
Background:
- Epilepsy surgery, including hemispherectomy, is increasingly used for pediatric intractable seizures linked to structural brain lesions.
- Accurate pre- and post-operative imaging is vital for surgical planning and management.
Purpose of the Study:
- To evaluate pre- and postoperative imaging findings in pediatric patients undergoing hemispherectomy.
- To establish a recommended radiologic evaluation protocol for hemispherectomy candidates.
Main Methods:
- Retrospective review of imaging (CT, MR, PET, EEG, angiography) and pathological findings in 29 pediatric patients (22 days to 19 years) who underwent hemispherectomy.
- Correlation of imaging findings with clinical outcomes and pathological diagnoses.
Main Results:
- Preoperative PET and EEG showed abnormalities but often lacked lesion characterization.
- CT/MR identified focal/unilateral lesions in 19/29 patients, providing crucial lesion nature information.
- Postoperative CT/MR detected early complications (hemorrhage, infection, hydrocephalus) and specific findings (septations, hemosiderin) associated with poor outcomes.
Conclusions:
- Hemispherectomy is a viable surgical option for pediatric intractable epilepsy with structural lesions.
- A comprehensive pre- and postoperative imaging protocol, including CT, MR, PET, EEG, and angiography, is essential for optimizing patient selection, surgical planning, and complication management.