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[EPILEPSY SURGERY IN CHILDREN: A SUMMARY OF A DECADE AT THE SOURASKY TEL AVIV MEDICAL CENTER]
Jonathan Roth1, Itzhak Fried2, Shlomi Constantini1
1Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University.
Insights
Pediatric epilepsy surgery can significantly improve or cure drug-resistant epilepsy. Early surgical evaluation in children is crucial for better outcomes and reduced developmental injury.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Context:
- Drug-resistant epilepsy in children presents significant challenges, including developmental regression and mortality.
- Surgical interventions are increasingly recognized for their role in managing refractory epilepsy.
- Technological advancements have led to less invasive surgical procedures with reduced morbidity.
Purpose:
- To review the outcomes of cranial surgery for epilepsy in children over a decade (2011-2020).
- To analyze the types of surgeries performed, their etiologies, complications, and epilepsy outcomes.
Summary:
- A total of 110 cranial surgeries were performed on 93 children for various epilepsy etiologies, including cortical dysplasia, Rasmussen encephalitis, and tumors.
- Procedures included lobectomies, focal resections, hemispherotomies, and callosotomies, with significant seizure improvement observed after hemispherotomy and tumor resection.
- Complications occurred in 23% of cases, but most had no permanent sequelae; no mortality was reported.
Impact:
- Epilepsy surgery offers a viable path to significant seizure reduction or complete cure in pediatric patients.
- Early referral for surgical evaluation can mitigate developmental injury and enhance functional outcomes in children with refractory epilepsy.
- A diverse range of epilepsy surgical procedures are available, tailored to specific patient needs and epilepsy types.
Introduction:
Drug-resistant epilepsy in children is associated with morbidity, developmental regression and mortality. Over recent years, there is an increase in awareness regarding the role of surgery in the treatment of refractory epilepsy, both in the diagnostic phase and for treatment, reducing the number and magnitude of seizures. Technological advancements have enabled a minimalization of surgery, with reduction in surgical associated morbidity.
Methods:
In this retrospective study, we review our experience with cranial surgery for epilepsy between the years 2011-2020. Collected data included information regarding the epileptic disorder, surgery, surgical-related complications and epilepsy outcome.
Results:
A total of 93 children underwent 110 cranial surgeries over a decade. The main etiologies included cortical dysplasia (29), Rasmussen encephalitis (10), genetic disorders (9), tumors (7) and tuberous sclerosis (7). The main surgeries included lobectomies (32), focal resections (26), hemispherotomies (25), and callosotomies (16). Two children underwent MRI-guided laser interstitial thermal treatment (LITT). The most significant improvements following surgery were following hemispherotomy or tumor resection (100% of children, each). Following resections for cortical dysplasia led to a significant improvement in 70%. In 83% of children undergoing callosotomy, there were no additional drop seizures; 14% of the entire group underwent additional epilepsy surgery; 23% of children had an unexpected complication, in the vast majority with no permanent sequela. There was not mortality.
Conclusions:
Epilepsy surgery may lead to significant improvement and even cure of epilepsy. There is a wide span of epilepsy surgical procedures. Ealy referral of children with refractory epilepsy for surgical evaluation may significantly reduce the developmental injury, and improve functional outcomes.