Microscopic and macroscopic infarct complicating pediatric epilepsy surgery.

Area of Science:

• Neurology
• Neurosurgery
• Pediatric Epilepsy

Background:

• Invasive monitoring in pediatric epilepsy surgery may be associated with microscopic infarct, but its link to imaging and neurological deficits is unclear.
• Assessing complication rates, including microscopic and macroscopic infarct, is crucial for evaluating the safety of pediatric epilepsy surgery.

Purpose of the Study:

• To determine the incidence of microscopic and macroscopic infarct following pediatric epilepsy surgery.
• To investigate whether invasive monitoring increases the risk of infarcts and major complications.
• To correlate infarcts with neurological deficits after surgery.

Main Methods:

• Retrospective review of epilepsy surgery data from a tertiary pediatric center.
• Analysis of microscopic infarct on histology and macroscopic infarct on postoperative CT/MRI.
• Comparison of complication rates between patients with and without invasive monitoring.

Main Results:

• Microscopic infarct occurred in 9% of patients, significantly higher with invasive monitoring (20% vs. 0.5%, p < 0.001).
• Macroscopic infarct occurred in 5% of patients, with no significant difference between invasive monitoring groups (8% vs. 3%, p = 0.085).
• Invasive monitoring was independently associated with microscopic infarct (OR 15.87, p = 0.009) but not macroscopic infarct or major complications.

Conclusions:

• Invasive monitoring is associated with an increased risk of microscopic infarct in pediatric epilepsy surgery patients.
• While microscopic infarcts did not result in permanent deficits, macroscopic infarcts were linked to persistent neurological deficits in some cases.
• The study highlights the need for careful consideration of invasive monitoring risks and benefits in pediatric epilepsy surgery.