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Postoperative Epileptic Seizures in Children
Luca Massimi1,2, Paolo Frassanito2, Federico Bianchi2
1Neuroscience Department, Catholic University Medical School, 00168 Rome, Italy.
Insights
Postoperative seizures (PS) are less common after pediatric craniotomy than previously thought. Hyponatremia is a key risk factor for PS in children undergoing surgery for brain tumors.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Epileptology
Background:
- Postoperative seizures (PS) affect 10-15% of patients undergoing craniotomy.
- Limited data exists on the specific role of surgery in pediatric PS, particularly excluding confounding factors.
- Understanding PS etiology is crucial for improving patient outcomes.
Purpose of the Study:
- To update the understanding of the role of surgery in pediatric postoperative seizures (PS).
- To compare seizure rates in children with intra-axial versus extra-axial supratentorial lesions.
- To identify risk factors for PS in this specific pediatric population.
Main Methods:
- Retrospective analysis of 165 children undergoing craniotomy for supratentorial lesions over 10 years.
- Exclusion criteria: preoperative seizures, perioperative antiepileptic drug prophylaxis, head injury, infections, re-operation, or preoperative hyponatremia.
- Comparison between children with intra-axial (Group 1) and extra-axial lesions (Group 2).
Main Results:
- PS occurred in 9% and epilepsy in 3% of cases (mean follow-up: 5.7 years).
- No significant differences in PS or epilepsy rates between intra-axial and extra-axial lesion groups.
- Hyponatremia was a significant risk factor for PS in the extra-axial lesion group (p=0.02).
Conclusions:
- Pediatric neurosurgery for supratentorial lesions has a lower rate of PS and epilepsy when excluding specific confounding factors.
- Hyponatremia is a significant predictor of PS in children with extra-axial lesions.
- While neurosurgery is generally safe, surgical complications can contribute to late-onset epilepsy.
Abstract:
Background: Postoperative seizures (PS) occur in 10−15% of patients. This study aims to provide an update on the role of surgery in PS. Methods: All children undergoing a craniotomy for supratentorial lesions in the last 10 years were considered except those with preoperative seizures, perioperative antiepileptic drugs prophylaxis, head-injury and infections, repeated surgery, or preoperative hyponatremia. Children undergoing surgery for intra-axial lesions (Group 1, 74 cases) were compared with those harboring extra-axial lesions (Group 2, 91 cases). Results: PS occurred in 9% of 165 cases and epilepsy in 3% of 165 cases (mean follow-up: 5.7 years). There was no difference between the two study groups with regard to demographic data or tumor size. Group 1 showed a higher rate of gross total tumor resection (p = 0.002), while Group 2 had a higher rate of postoperative hyponatremia (p < 0.0001). There were no differences between the two groups in the occurrence of seizures (6.7% vs. 11%) or epilepsy (2.7% vs. 3.2%). No correlations were found between seizures and age, tumor location, histotype, tumor size, or the extent of tumor resection. Hyponatremia affected the risk of PS in Group 2 (p = 0.02). Conclusions: This study shows a lower rate of PS and epilepsy than series including children with preoperative seizures. Hyponatremia has a significant role. Neurosurgery is safe but surgical complications may cause late epilepsy.
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