Proportion of resected seizure onset zone contacts in pediatric stereo-EEG-guided resective surgery does not correlate with outcome
Related Experiment Video
Updated: Sep 28, 2025
Operative Technique and Nuances for the Stereoelectroencephalographic SEEG Methodology Utilizing a Robotic Stereotactic Guidance System
Published on: June 9, 2023
Mehdi Khan1, Aswin Chari2, Kiran Seunarine2
1University College London Medical School, London, UK; Department of Neurosurgery, Great Ormond Street Hospital, London, UK.
Insights
Resecting more seizure onset zone (SOZ) contacts did not improve seizure outcomes in pediatric epilepsy surgery. Histopathology, not the extent of resection, was the key predictor of seizure freedom after surgery.
Area of Science:
- Neurosurgery
- Epileptology
- Pediatric Neurology
Background:
- Epilepsy surgery aims to resect the seizure onset zone (SOZ).
- Stereoelectroencephalography (SEEG)-guided resective surgery is used in complex pediatric epilepsy cases.
- Predicting surgical success remains a challenge.
Purpose of the Study:
- To investigate the association between the proportion of resected SOZ contacts and seizure outcome in children.
- To identify factors influencing seizure freedom after SEEG-guided epilepsy surgery.
Main Methods:
- Retrospective analysis of pediatric patients undergoing SEEG-guided resective surgery.
- Quantification of resected SOZ contacts using pre- and post-operative imaging.
- Classification of seizure outcome as seizure-free (SF) or not seizure-free (NSF).
Main Results:
- Fifteen of 22 analyzed patients (68.2%) achieved seizure freedom at median follow-up.
- Histopathology was the only significant factor associated with seizure freedom on univariate analysis.
- The percentage of SOZ contacts resected was not significantly associated with seizure outcome (p=0.89).
Conclusions:
- The proportion of resected SOZ contacts does not correlate with seizure outcome in pediatric SEEG-guided epilepsy surgery.
- Histopathology emerges as a critical predictor of surgical success.
- Other factors like epileptogenic zone organization and biomarkers may influence outcomes.
Objective:
We aimed to determine whether the proportion of putative seizure onset zone (SOZ) contacts resected associates with seizure outcome in a cohort of children undergoing stereoelectroencephalography (SEEG)-guided resective epilepsy surgery.
Methods:
Patients who underwent SEEG-guided resective surgery over a six-year period were included. The proportion of SOZ contacts resected was determined by co-registration of pre- and post-operative imaging. Outcome was classified as seizure free (SF, Engel class I) or not seizure-free (NSF, Engel class II-IV) at last clinical follow-up.
Results:
Twenty-nine patients underwent resection of whom 22 had sufficient imaging data for analysis (median age at surgery of 10 years, range 5-18). Fifteen (68.2%) were SF at median follow-up of 19.5 months (range 12-46). On univariate analysis, histopathology, was the only significant factor associated with SF (p < 0.05). The percentage of defined SOZ contacts resected ranged from 25-100% and was not associated with SF (p = 0.89). In a binary logistic regression model, it was highly likely that histology was the only independent predictor of outcome.
Conclusions:
The percentage of SOZ contacts resected was not associated with SF in children undergoing SEEG-guided resective epilepsy surgery.
Significance:
Factors such as spatial organisation of the epileptogenic zone, neurophysiological biomarkers and the prospective identification of pathological tissue may therefore play an important role.
More Related Videos
05:54Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
Published on: June 13, 2016
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016