Assessing risk of hemorrhage prior to pediatric epilepsy surgery
Abstract number :
2.403
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2025
Submission ID :
682
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Alexandra Gamber, MD – Detroit Medical Center - Children's Hospital of Michigan
Erika Mann, MD – University of Michigan
Garnett Smith, MD – University of Michigan
Jessica Paige Rieckhoff, NP – University of Michigan
Kerri Neville, MD – University of Michigan
Neena Marupudi, MD – University of Michigan
Hugh Garton, MD, PhD – University of Michigan
Erin Fedak Romanowski, DO – University of Michigan
Nancy McNamara, MD – University of Michigan
Rationale: Pediatric epilepsy surgery is a key component to treatment of intractable epilepsy, often being the only curative option for some patients. Routine laboratory screening is not done prior to pediatric epilepsy surgery. At our institution, after a sentinel patient developed bilateral temporal venous hemorrhages following sEEG removal, and was found to have previously undiagnosed von Willebrand Disease (vWD), we initiated clinical and laboratory pre-surgical screening including PT/PTT/INR, fibrinogen, and vWD panel for all patients prior to pediatric epilepsy surgery procedures (resective, disconnective, or phase 2 monitoring). This study was designed to evaluate the incidence of bleeding disorders detected through pre-surgical screening, and the implications of presurgical screening on surgical timing and outcomes.
Methods: We performed a retrospective chart review on all pediatric patients (0-21 years) who underwent epilepsy surgery at our institution between the years 2016-2024. We evaluated the rates of hemorrhage, clinical risks for bleeding, and hematologic laboratory results.
Results: Pre-surgical screening was initiated in mid 2022. Of the 101 patients who underwent epilepsy surgery at our institution between 2016-2024, 21 patients had presurgical hematological screening. 3 patients had hemorrhage secondary to epilepsy surgery prior to initiation of hematologic screening. After the initiation of presurgical screening, 7 patients were found to have abnormal hematologic labs prior to epilepsy surgery. Of these patients, 4 were referred to hematology for further evaluation, and one received a new diagnosis of hemophilia B. Two additional patients were treated with aminocaproic acid and/or von Willebrand factor pre- and post-operatively. Two patients had delays in their planned surgeries. There were no cases of hemorrhage after initiating a hematologic screening protocol.
Conclusions: Epilepsy surgery can be life-changing and for some patients, curative of their intractable epilepsy and should be a low risk, high benefit procedure. However, all neurosurgical procedures, including phase 2 monitoring, come with the risk of hemorrhage, and undiagnosed mild bleeding disorders can be clinically undetected in children prior to significant injury or surgery. Though our case series is small and from a single institution, with laboratory screening only we identified 1 patient with undiagnosed hemophilia B. This infant ultimately underwent a functional hemispherotomy for Sturge Weber Syndrome, one of the highest risk surgeries for hemorrhage. In this case, screening was potentially life saving as this patient ultimately had no hemorrhage with appropriate prophylactic factor infusion. Though this case series is small, and further large study is needed to produce complete guidelines, the impact was significant for our cohort. We recommend consideration for universal clinical and laboratory screening for undiagnosed bleeding disorders prior to pediatric epilepsy surgery, including phase 2 monitoring.
Funding: No funding was received in support of this abstract.
Surgery