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Updated: Jan 2, 2026
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Uncovering homonymous visual field defects in candidates for pediatric epilepsy surgery
Lisa Neumayr1, Tom Pieper2, Manfred Kudernatsch3
1Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Klinik Vogtareuth, Vogtareuth, Germany; Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.
Insights
Campimetry is an effective method for detecting homonymous visual field defects (HVFDs) in children undergoing epilepsy surgery. Strabismus and anomalous head posture are key clinical indicators of HVFDs in this population.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Neurosurgery
Background:
- Diagnosing visual field defects in children, particularly those with epilepsy, is challenging due to cooperation issues.
- Homonymous visual field defects (HVFDs) are critical for surgical planning in pediatric epilepsy.
- Current perimetry methods are often difficult for young patients.
Purpose of the Study:
- To evaluate campimetry as a visual field testing method for children.
- To identify clinical signs, such as strabismus and anomalous head posture, indicative of HVFDs in pediatric patients.
Main Methods:
- Campimetry and standard orthoptic examinations were performed on pediatric patients undergoing epilepsy surgery and those with suspected HVFDs.
- A cohort of 18 epilepsy surgery patients and 11 additional patients with suspected HVFDs were included.
Main Results:
- Campimetry was successfully completed in 16/18 epilepsy surgery patients.
- Preoperative HVFDs were present in 5/16 patients, and 4/16 developed new HVFDs post-surgery.
- Strabismus (6/12 with HVFDs) and anomalous head posture (8/12 with HVFDs) were specific indicators of HVFDs.
Conclusions:
- Campimetry is a valuable tool for early detection and delineation of HVFDs in children with limited cooperation.
- Pediatric epilepsy surgery patients show a high prevalence of HVFDs (9/16).
- Clinicians should recognize strabismus and anomalous head posture as potential indicators of HVFDs in epilepsy surgery contexts.
Objectives:
Perimetry in children can be challenging due to low cooperation and short attention span. Especially during the pre-surgical work-up of children with pharmaco-refractory epilepsies, however, diagnosing homonymous visual field defects (HVFDs) can be crucial for planning surgical strategies. Here, we evaluated "campimetry" for visual field testing in children. Furthermore, we analyzed strabismus and anomalous head posture as clinical signs for HVFDs.
Methods:
Campimetry and a standard orthoptic examination were performed in 18 patients (age range: 3 y 2 m-18 y) who underwent epilepsy surgeries in our center during the study period, and in 11 additional patients (age range: 2 y 10 m-22 y 10 m) with suspected or confirmed HVFDs.
Results:
In 16/18 patients of our unselected surgery cohort, pre- and postoperative campimetry was successfully completed. Of these, only 7/16 patients had intact visual fields pre- and postoperatively, while 5/16 patients already showed preoperative HVFDs and 4/16 patients suffered newly acquired HVFDs as calculated consequences of the surgery. Regarding clinical signs, strabismus (mostly esotropia) and anomalous head posture were specific indicators of HVFDs (strabismus: 6/12 with HVFDs vs 1/18 without; anomalous head posture: 8/12 with HVFDs vs 0/18 without).
Conclusions:
For perimetry in children with limited cooperation, we suggest campimetry as it allows early detection and fast delineation of HVFDs. This is particularly important in pediatric epilepsy surgery patients, who display a surprisingly high proportion of HVFDs (9/16). Both, strabismus and anomalous head posture can indicate such HVFDs. Therefore, clinicians should pay attention to these clinical signs, especially in the context of epilepsy surgery.
