Authors :
Presenting Author: Friedhelm C Schmitt, MD – University Of Magdeburg
M. Benjamin Larkin, MD – Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA; Anthony Allam, Student – Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA; Irfan Ali, MD – Dpt. of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; James Riviello, MD – Dpt. of Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Angus Wilfong, MD – Dpt. of Pediatric Neurology, Phoenix Children's Hospital. University of Arizona. Phoenix, Arizona, USA; Howard Weiner, MD – Division of Pediatric Neurosurgery, Dpt. of Neurosurgery & Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA; Sandi Lam, MD – Department of Neurological Surgery, McGaw Medial Center of Northwestern University, Chicago, IL, USA; Division of Pediatric Neurosurgery, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Daniel Curry, MD – Division of Pediatric Neurosurgery, Dpt. of Neurosurgery & Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
Rationale:
MRgLITT is well established minimal invasive surgical procedure in drug resistant focal epilepsy, especially for temporal lobe epilepsy (TLE)[1, 5]. However, only single cases of pediatric patients have been reported in larger series [1, 2]. Pediatric temporal lobe epilepsies (pedTLE) are unique and clearly distinguishable from adult cases [4] characteristics in terms of the epileptic zone, underlying etiologies, comorbidities and consequently require additional localizing (such as stereo-EEG-based-MRgLITT [3]) for surgery to be effective. We report on seizure outcome, surgical and nonsurgical complications in a consecutive series of pedTLE patients from August 2010 to February 2022 in a single referral center for pediatric epilepsy.
Methods:
We analyzed retrospectively all records of all operated patients with pedTLE, standard follow-up (FU) visits were three month, six month and twelve months and every following year post op. The outcome was defined by the Engel-outcome classification.
Results:
All 36 patients were diagnosed drug resistant temporal lobe epilepsy after standard presurgical assessment. Two were lost for FU. From 34 patients (13 female) the age at surgery varied between 3.4 to 20.7 years (mean 14.3 ± 4.8) and epilepsy duration between 0.6 to 20.2 years (mean 8.9 ± 5.3). The number of surgical interventions (all together 41 ablations, 7 resection and 1 RNS-implantation) per patient varied 1 to 3 (median: 1), eighteen patients (52,9 %) required stereo-EEG based MRgLITT.
Surgical complications for MRgLITT was transient wound healing (1 patient), headache (1 patient), transient nerve palsy (3 patients), non-functional hemorrhage (2 patients), incomplete ablation (2 patients) and “problematic CSF collection“ (1 patient) (i.e., 17.1% transient and 12.2% permanent complications and 7.3% functionally relevant, here two patients required reablation). Complication for open resections were one functionally relevant infarct and two functionally non-relevant superior quadrantopia (i.e. 0 transient and permanent 42%, however only 14% functionally relevant).
Maximal follow-up period ranged from 1.0 to 9.5 years (median 3.0). Postsurgical seizure outcome was Engel Class I 50%, Engel Class II 12%, Engel Class III 15% and Engel Class IV. 1 year FU, 2 year FU und 5 FU Engel Class I varied between 56%, 59% and 57 % (with 0, 6, and 7 patients lost for follow-up in the respective time period).
Conclusions:
This monocentric study showed a 56% rate of seizure freedom after one year and 50% seizure outcome after a multiple procedure step-by-step approach in the last available follow-up. The concept of stereo-EEG-based-MRgLITT was necessary in more than half of the patients. Increased postsurgical complication rate in resective surgery reflects MRgLITT-superiority for minimal invasiveness in this specific patient group.
Funding: None