Postoperative Epileptic Seizures in Children: Is the Brain Incision a Risk Factor?

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Epileptology

Background:

• Postoperative seizures (PSs) are common after neurosurgery, but the role of surgical brain incision in their development is unclear.
• This study addresses the impact of cortical incision on seizure genesis in pediatric neurosurgery patients.

Purpose of the Study:

• To determine if brain corticotomy influences the risk of PSs and postoperative epilepsy (PE) in children undergoing neurosurgery.
• To investigate the relationship between surgical approach and seizure development in pediatric neurosurgical cases.

Main Methods:

• Retrospective review of 143 pediatric patients with supratentorial lesions operated on over 15 years.
• Patients were divided into two groups: Group A (corticotomy for hemispheric tumors) and Group B (extracortical approaches for suprasellar/optic tumors).
• Exclusion of patients with preoperative seizures to isolate the effect of surgery.

Main Results:

• No significant difference in the incidence of PSs (11.7% vs 14.5%) or PE (4.5% vs 6.5%) between Group A and Group B after a mean 6.8-year follow-up.
• The size of corticotomy (<3 cm2 vs >3 cm2) did not impact epileptogenesis.
• Other variables like age, sex, and extent of resection also showed no impact on seizure development.

Conclusions:

• Surgical cortical trauma is not identified as a risk factor for PSs or PE in pediatric neurosurgery.
• Electrolytic imbalance and brain gliosis are suggested as more significant contributing factors to postoperative seizures.
• Findings are crucial for surgical planning and postoperative management, with a need for validation in adult and prospective studies.