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Surgical pathology of epilepsy resections in childhood
1Department of Pathology, Hospital for Sick Children-University of Toronto, Ontario, Canada.
Insights
Pediatric epilepsy surgery reveals common "lesional" abnormalities on imaging, with dual pathology more frequent than mesial temporal sclerosis. Neuronal migration disorders and gliomas are prevalent, sometimes with mixed components.
Area of Science:
- Pediatric Neuropathology
- Epilepsy Surgery
- Neuroradiology
Background:
- Medically refractory epilepsy in children often necessitates surgical intervention.
- Temporal lobectomies and neocortical resections are common surgical procedures.
- Accurate pathological diagnosis is crucial for understanding treatment outcomes.
Purpose of the Study:
- To review important pathological lesions identified in pediatric epilepsy surgeries.
- To compare the frequency of different lesion types in pediatric epilepsy.
- To investigate potential etiologies like cytomegalovirus in specific conditions.
Main Methods:
- Review of pathological findings from temporal lobectomies and neocortical resections.
- Analysis of neuroimaging (CT and MRI) in conjunction with histopathology.
- Correlation of lesion types with clinical presentation and outcomes.
Main Results:
- A significant proportion of pediatric cases exhibit identifiable "lesional" abnormalities on CT and MRI.
- "Dual pathology" (multiple distinct lesions) is more common than isolated mesial temporal sclerosis.
- Neuronal migration disorders and low-grade gliomas constitute approximately one-third of cases, with some showing combined neoplastic and malformative features.
Conclusions:
- Pediatric epilepsy surgery cases frequently present with identifiable lesions on imaging.
- The spectrum of pathology in pediatric epilepsy surgery is diverse, including developmental abnormalities and neoplasms.
- Cytomegalovirus is suggested as a potential contributor in some cases of Rasmussen's encephalitis.
Abstract:
In this review, we discuss the important pathological lesions observed in temporal lobectomies and neocortical resections performed for medically refractory seizures in children. A higher percentage of pediatric cases appear to be "lesional" with computed tomography (CT) and magnetic resonance imaging (MRI) and abnormalities and "dual pathology" lesions appear to be more common than pure mesial temporal sclerosis. Almost a third of cases appear to be neuronal migration disorders and low-grade gliomas with some lesions harboring both neoplastic and malformative components. Our experience suggests a role for cytomegalovirus in some cases of Rasmussen's encephalitis.