Postoperative Epileptic Seizures in Children.

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.