Related Experiment Video
Updated: May 6, 2026
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Safety of staged epilepsy surgery in children
Jonathan Roth1, Chad Carlson, Orrin Devinsky
1*Division of Pediatric Neurosurgery, Department of Neurosurgery, ‡The Comprehensive Epilepsy Center, NYU Langone Medical Center, New York University School of Medicine, New York, New York; §Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel; ‖Department of Neurology, The Medical College of Wisconsin, Milwaukee, Wisconsin.
Insights
Staged epilepsy surgery using invasive monitoring is a safe treatment for children with difficult-to-treat epilepsy. Major complications are infrequent and comparable to other neurosurgical procedures.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Surgical Neurology
Background:
- Accurate localization of the epileptogenic zone is crucial for successful epilepsy surgery.
- Medically refractory epilepsy in children often requires invasive monitoring for precise focus localization.
- A staged surgical protocol involving invasive monitoring has been employed for selected pediatric cases.
Purpose of the Study:
- To assess the safety and complication rates of staged surgical treatments for refractory epilepsy in children.
- To evaluate the efficacy of invasive monitoring in localizing the epileptogenic zone for surgical resection.
- To compare the safety profile of staged epilepsy surgery with other elective neurosurgical procedures.
Main Methods:
- Retrospective data collection of surgical details and complications from children undergoing invasive monitoring.
- Analysis of 200 admissions and 496 surgeries in 161 children over a follow-up period of up to 10 years.
- Categorization of complications into major and minor, and assessment of those requiring additional surgical intervention.
Main Results:
- No deaths occurred in 161 children undergoing staged epilepsy surgery.
- Major complications occurred at low rates: neurological deficits (2%), infections (1.5%), hemorrhage (0.5%), CSF leak (0.5%), retained hardware (0.5%).
- Minor complications included bone absorption (5%), asymptomatic positive cultures (5.5%), fever (5%), and wound issues (3%).
Conclusions:
- Staged epilepsy surgery with invasive electrode monitoring is a safe therapeutic option for children with poorly localized, medically refractory epilepsy.
- The incidence of major complications is low and comparable to established elective neurosurgical procedures.
- This approach facilitates accurate localization and resection of epileptic foci, improving outcomes for challenging pediatric epilepsy cases.
Background:
Surgical resection of epileptic foci relies on accurate localization of the epileptogenic zone, often achieved by subdural and depth electrodes. Our epilepsy center has treated selected children with poorly localized medically refractory epilepsy with a staged surgical protocol, with at least 1 phase of invasive monitoring for localization and resection of epileptic foci.
Objective:
To evaluate the safety of staged surgical treatments for refractory epilepsy among children.
Methods:
Data were retrospectively collected, including surgical details and complications of all patients who underwent invasive monitoring.
Results:
A total of 161 children underwent 200 admissions including staged procedures (>1 surgery during 1 hospital admission), and 496 total surgeries. Average age at surgery was 7 years (range, 8 months to 16.5 years). A total of 250 surgeries included resections (and invasive monitoring), and 189 involved electrode placement only. The cumulative total number of surgeries per patient ranged from 2 to 10 (average, 3). The average duration of monitoring was 10 days (range, 1-30). There were no deaths. Follow-up ranged from 1 month to 10 years. Major complications included unexpected new permanent mild neurological deficits (2%/admission), central nervous system or bone flap infections (1.5%/admission), intracranial hemorrhage, cerebrospinal fluid leak, and a retained strip (each 0.5%/admission). Minor complications included bone absorption (5%/admission), positive surveillance sub-/epidural cultures in asymptomatic patients (5.5%/admission), noninfectious fever (5%/admission), and wound complications (3%/admission). Thirty complications necessitated additional surgical treatment.
Conclusion:
Staged epilepsy surgery with invasive electrode monitoring is safe in children with poorly localized medically refractory epilepsy. The rate of major complications is low and appears comparable to that associated with other elective neurosurgical procedures.
