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Published on: December 18, 2016
Predictors of Surgical Failure in Pediatric Lesional Temporal Lobe Epilepsy Surgery
Matthias Tomschik1, Katharina Moser2, Robert Diehm2
1Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Insights
Pediatric epilepsy surgery offers long-term seizure freedom for many children with temporal lobe epilepsy (TLE). However, less extensive resections and specific seizure types increase the risk of surgical failure.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Surgical Outcomes Research
Background:
- Pharmacoresistant temporal lobe epilepsy (TLE) in children can be treated with epilepsy surgery.
- Surgical failures, resulting in persistent seizures, remain a concern.
- This study identifies risk factors for surgical failure in pediatric TLE patients.
Purpose of the Study:
- To evaluate the outcomes of resective temporal lobe surgery in pediatric patients.
- To identify predictors of surgical failure in this population.
- To analyze the impact of resection strategy and seizure characteristics on outcomes.
Main Methods:
- Prospective data collection of pediatric TLE patients undergoing surgery.
- Minimum three-year follow-up (FU) for all patients.
- Stratification of resections into extended (anterior temporal lobectomies) and sparing (lesionectomies, selective amygdalohippocampectomies) types.
- Definition of surgical failure as ongoing seizures or relapses within three years.
Main Results:
- 96 pediatric TLE patients (43 sparing, 52 extended resections) with median FU of 10.1 years.
- Common pathologies included tumors (44.8%), hippocampal sclerosis (37.5%), and focal cortical dysplasias (12.5%).
- Seizure freedom rates were 69.8% at 1 year, 78.5% at 5 years, and 72.9% at 10 years.
- Sparing resections (OR: 4.63, P=0.006) and preoperative focal to bilateral tonic-clonic seizures (OR: 2.79, P=0.002) were associated with higher odds of surgical failure.
Conclusions:
- Pediatric TLE surgery demonstrates high rates of long-lasting seizure control.
- Resection strategy significantly impacts early surgical success, favoring larger resections.
- Preoperative focal to bilateral tonic-clonic seizures predict higher relapse rates and surgical failure.
Background:
Epilepsy surgery can potentially cure pharmacoresistant temporal lobe epilepsy (TLE) in children. However, surgical failures, where patients continue to experience seizures, still exist. We evaluated outcomes in pediatric patients after resective temporal lobe surgery to identify risk factors for failure.
Methods:
Data on pediatric patients with TLE who underwent surgery were prospectively collected at our institution. Minimum follow-up (FU) was three years after surgery. Resections were stratified into extended resections, i.e., anterior temporal lobectomies, and sparing resections, i.e., lesionectomies and selective amygdalohippocampectomies. Ongoing seizures and relapses within the first three years were considered surgical failures.
Results:
We included 96 patients after 43 sparing and 52 extended resections from 1993 to 2019 with a median FU of 10.1 years (range 3.0 to 28.3 years). Pathohistology most frequently revealed epilepsy-associated tumors (44.8%), hippocampal sclerosis (37.5%), and focal cortical dysplasias (12.5%). One year postoperatively, 69.8% were seizure free, increasing to 78.5% after five and 72.9% after 10 years. Sparing resections increased the odds for surgical failure in a multivariate analysis (odds ratio: 4.63, P = 0.006). Preoperative focal onset to bilateral tonic-clonic seizures increased the likelihood of seizure relapses (hazard ratio: 3.89, P = 0.006) and contributed to higher odds of surgical failure (odds ratio: 2.79, P = 0.002).
Conclusions:
Pediatric patients with TLE undergoing surgery have high rates of long-lasting favorable seizure outcomes. Resection strategy is a prognostic factor for early surgical success in favor of larger resections. Relapses were more frequent in children with focal onset to bilateral tonic-clonic seizures beforesurgery.
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