Abstracts

Rationale: A web-based questionnaire was sent to several centers with a wide geographical representation in order to try to understand the present practice status around the world. In this paper we describe the findings related to surgical strategy. Methods: A web-based survey comprising 24 questions was filled up by 52 centers representing all continents. Results: Eighty percent of the centers did not perform awake surgery in kids; 59% would perform surgery for children in status epilepticus. A mean of 24% of the children with temporal lobe epilepsy were submitted to invasive monitoring: of them, 22% with depth electrodes, 52% with subdural electrodes and 24% with both subdural and depth electrodes. Sixty-seven percent of the surgeons performed a cortico-amygdalo-hipocampectomy in patients with mesial temporal sclerosis; 46% of those who performed lateral cortical removals used Spencer's like resections. Sixty-seven percent of the surgeons performed intraoperative electrocorticography in patients with neocortical temporal lobe epilepsy. In patients with temporal lobe tumors and refractory epilepsy, 30% of the surgeons would remove the portion of the hippocampus near the lesion only if the tumor did not invade the hippocampus, but 40% of the surgeons would remove the whole hippocampus on both sides if the tumor encroached on the hippocampus. In patients with temporal lobe tumors with few seizures, a more limited approach was observed: 61% and 34% of the surgeons would remove only the portion of the hippocampus near the lesion, wheather they did not or positively encroached on the hippocampus, respectively. In children with cavernoma and both refractory epilepsy or few seizures, 86% of the surgeons always removed the surrounding hemosiderin ring. Sixty-seven percent of the surgeons removed additional cortex in patients with cortical dysplasia. 55% of the surgeons performed complete callosotomy.; 34% performed perinsular hemispherotomy. Fifty-nine percent of the surgeons modified their surgical technique according to etiology while performing hemispheric surgery; infarcts were the main etiology for patients undergoing hemispheric surgery (26%). Mean volume of blood transfused during hemispheric surgery was 232 ml. The mean number of febrile days in children with a postoperative aseptic meningitis syndrome was 4.2 days; 59% of the centers performed CSF sampling if aseptic meningitis was suspected, and 28% initiated steroids for treatment. Complications extending the hospital stay were noted in 3.8% of the patients submitted to cortical resection, 9.9% to hemispheric surgery, 5% to callosotomy, 1.8% to depth electrode implantation, 5.9% to subdural grids implantation, 11.9% to hypothalamic hamarthoma resection, 0.9 to VNS, and 0.5 to DBS. Conclusions: There was wide variability throughout most of the items investigated. There were no clear geographic or country specific differences. Some of that might be related to the "surgical school" where the surgeon was trained. On the other hand, many of these issues should not be "school"-related, and would need adequate RCTs to be further investigated.