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Updated: Jun 12, 2026
Stereo-Electro-Encephalo-Graphy (SEEG) With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
Published on: June 13, 2016
Surgery for catastrophic epilepsy in infants 6 months of age and younger
Shaila Gowda1, Fortino Salazar, William E Bingaman
1Department of Neurology, Providence Park Hospital, Novi, Michigan 48374, USA. ssrinath03@yahoo.com
Insights
Epilepsy surgery in infants under six months can be effective, with 46% seizure-free. However, significant challenges include substantial blood loss and potential neurological deficits.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Developmental Neuroscience
Background:
- Catastrophic epilepsy in early infancy presents significant challenges with limited treatment options.
- Surgical interventions for severe epilepsy in infants are not well-documented regarding efficacy and safety.
Purpose of the Study:
- To evaluate the safety and efficacy of epilepsy surgery in infants within the first six months of life.
- To assess outcomes for catastrophic epilepsy in neonates and young infants.
Main Methods:
- Retrospective analysis of 15 infants (1.5-6 months old) undergoing epilepsy surgery.
- Procedures included anatomical/functional hemispherectomy and focal resections for malformation of cortical development.
Main Results:
- No mortality was observed.
- Significant intraoperative blood loss requiring transfusion occurred in all cases (median 63% total blood volume).
- 46% of patients achieved seizure freedom at a median follow-up of 60 months.
Conclusions:
- Epilepsy surgery can be effective in very young infants, similar to older children.
- Managing intraoperative blood loss and preventing neurological deficits are critical challenges.
Object:
Few data are available concerning efficacy and safety of surgery for catastrophic epilepsy in the first 6 months of life.
Methods:
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.
Results:
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.
Conclusions:
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.
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