Epilepsy surgery in COVID times-a unique conundrum

Area of Science:

• Neurosurgery
• Epileptology
• Infectious Disease Epidemiology

Background:

• Hospital admissions were prioritized during the COVID-19 pandemic, leading to postponed epilepsy surgeries.
• Patients with drug-refractory epilepsy (DRE) face prolonged treatment denial, raising concerns about disease progression.

Purpose of the Study:

• To evaluate the feasibility and outcomes of performing epilepsy surgery during the COVID-19 pandemic.
• To present a case study of a child with Rasmussen's encephalitis undergoing surgery amidst the pandemic.

Main Methods:

• A multidisciplinary team discussed the risks and benefits of surgery with the patient's parents.
• Endoscopic left hemispherotomy was performed on a 12-year-old child with severe DRE and Rasmussen's encephalitis.
• Postoperative care included managing a mild hospital-acquired COVID-19 infection.

Main Results:

• The patient became seizure-free after the endoscopic hemispherotomy.
• The patient contracted a mild COVID-19 infection post-surgery, which was successfully treated.
• The case demonstrates successful surgical intervention despite pandemic-related challenges.

Conclusions:

• Selected severe DRE cases benefiting from surgery should be prioritized, even during a pandemic.
• A careful risk-benefit analysis is essential, weighing surgical outcomes against potential COVID-19 acquisition.
• Re-categorizing high-risk epilepsy surgery patients is recommended for timely intervention.