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Updated: Mar 8, 2026
Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
Microscopic and macroscopic infarct complicating pediatric epilepsy surgery
Luc Rubinger1, Lili-Naz Hazrati2, Raheel Ahmed3
1Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
Objective:
There is some suggestion that microscopic infarct could be associated with invasive monitoring, but it is unclear if the microscopic infarct is also visible on imaging and associated with neurologic deficits. The aims of this study were to assess the rates of microscopic and macroscopic infarct and other major complications of pediatric epilepsy surgery, and to determine if these complications were higher following invasive monitoring.
Methods:
We reviewed the epilepsy surgery data from a tertiary pediatric center, and collected data on microscopic infarct on histology and macroscopic infarct on postoperative computed tomography (CT) or magnetic resonance imaging (MRI) done one day after surgery and major complications.
Results:
Three hundred fifty-two patients underwent surgical resection and there was one death. Forty-two percent had invasive monitoring. Thirty patients (9%) had microscopic infarct. Univariable analyses showed that microscopic infarct was higher among patients with invasive monitoring relative to no invasive monitoring (20% vs. 0.5%, respectively, p < 0.001). Eighteen patients (5%) had macroscopic infarct on CT or MRI. Univariable analysis showed no significant difference in macroscopic infarct between invasive monitoring and no invasive monitoring (8% vs. 3%, respectively, p = 0.085). One patient with microscopic infarct had transient right hemiparesis, and two with both macroscopic and microscopic infarct had unexpected persistent neurologic deficits. Thirty-two major complications (9.1%) were reported, with no difference in major complications between invasive monitoring and no invasive monitoring (10% vs. 7%, p = 0.446). In the multivariable analysis, invasive monitoring increased the odds of microscopic infarct (odds ratio [OR] 15.87, p = 0.009), but not macroscopic infarct (OR 2.6, p = 0.173) or major complications (OR 1.4, p = 0.500), after adjusting for age at surgery, sex, age at seizure onset, operative type, and operative location.
Significance:
Microscopic infarct was associated with invasive monitoring, and none of the patients had permanent neurologic deficits. Macroscopic infarct was not associated with invasive monitoring, and two patients with macroscopic infarct had persistent neurologic deficits.
Insights
Pediatric epilepsy surgery patients undergoing invasive monitoring had higher rates of microscopic infarct, but this did not lead to permanent neurologic deficits. Macroscopic infarct was not linked to invasive monitoring, though some cases resulted in persistent deficits.
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.
