Authors :
Presenting Author: Kara Hom, BA – George Washington University School of Medicine and Health Sciences
Kathryn Havens, PA-C – Children's National Hospital; Tayyba Anwar, MD – Children's National Hospital; Dewi Depositario-Cabacar, MD – Children's National Hospital; Amisha Patel, MD – Children's National Hospital; John Schreiber, MD – Children's National Hospital; Tammy Tsuchida, MD – Children's National Hospital; Thuy-Anh Vu, MD – Children's National Hospital; Susanne Yoon, MD – Children's National Hospital; Tesfaye Zelleke, MD – Children's National Hospital; Chima Oluigbo, MD – Children's National Hospital; William Gaillard, MD – Children's National Hospital; Nathan Cohen, MD – Children's National Hospital
Rationale:
The primary goal of epilepsy surgery is cure. Lesional cases with discrete imaging findings and concordant electrophysiologic data can often be treated with resection with seizure-free outcomes reported in 60-75% of cases. In cases of surgical failure, stereoelectroencephalography (sEEG) is an emerging technique to guide reoperation with definition of the epileptogenic zone. This observational study aimed to evaluate surgical outcomes of sEEG-guided lesional reoperations.
Methods:
We conducted a single-center, retrospective review of patients from December 2016 to May 2023 who underwent lesional reoperations from an epilepsy surgery database maintained by Children’s National Hospital in Washington, DC. Patients were included if their initial resection was conducted without sEEG implantation but whose reoperation included sEEG monitoring. Patients were excluded if they underwent ablation surgery or had multiple operations prior to SEEG monitoring.
Results:
Eight patients who underwent sEEG monitoring for a lesional reoperation were included. The median age of seizure onset was 60 months (IQR 33-126). The median age at initial lesional resection was 104 months (IQR 69-178.5) and at reoperation was 165.5 months (IQR 95.5-186.25). The median duration of follow-up time after reoperation was 10 months (IQR 10-16). A total of 12.5% (n=1) of patients achieved Engel I outcome (seizure freedom), 62.5% (n=5) of patients achieved Engel II (improved seizure control), 25% (n=2) had Engel IV outcome. The main pathology found at reoperation include focal cortical dysplasia (n=6), neuronal migration disorder (n=1), and gliosis (n=1). Three patients had intraoperative MRI imaging with the initial resection, all of whom showed intraoperative imaging results demonstrating complete resection without complication. No primary operation MRI results were available for one patient as their initial resection was conducted at an outside hospital. The remaining patients had postoperative MRI imaging, which showed complete resection for two patients and small residual dysplasia for two patients. No sEEG-guided reoperation used intraoperative MRI.
Conclusions:
EEG may play a helpful role in improving lesional reoperation outcomes in pediatric pharmacoresistant epilepsy. This study found that 12.5% of patients achieved seizure-freedom, and 75% of patients achieved excellent seizure outcomes (Engel I or II) with reoperation after sEEG monitoring.
Funding:
KLH is funded by the American Academy of Neurology Medical Student Summer Research Scholarship and a W.T. Gill Fellowship from GWU School of Medicine. NTC is supported by the Pediatric Epilepsy Research Foundation/Child Neurology Foundation Shields Research Grant, the Children’s National Research Institute Chief Research Officer Award. This work was also supported by DC-IDDRC NICHD NIH P50 HD105328. This publication was supported by Award Number UL1TR001876 from the NIH National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.