Abstracts

Rationale: There is a wide variability of surgical techniques used among the different pediatric epilepsy surgery centers. 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 general surgical issues. Methods: A web-based survey comprising 14 questions was filled up by 52 centers representing all continents. Questions investigated the number of procedures / year, the type of procedures carried out, operating room approaches as for hair shaving, use of steroids, mannitol, valproate and antibiotics, and technical issues related to flaps opening and closing. The peroperative and postoperative use of imaging was also investigated. The materials / drugs used for anesthesia, skin prep, hemosthasis and dural replacement were evaluated. Results: The mean number of procedures per year was 48. All centers performed resective and disconnective procedures. Ninety-six percent of the centers carried out lesionectomy, 88% VNS, 51% multiple subpial transaction, 17% laser ablation, 13% thermocoagulation, and 9% DBS. 36.5% of the centers withdraw valproate before surgery. Intraoperatively, 48% of the surgeons shaved the hair, 40% used steroids, 21% used mannitol, 98% used prophylactic antibiotics. Forty-six percent of the centers gave intravenous AEDs during surgery. Eight eight percent of the surgeons used high-speed drills for craniotomy, 67% closed the skin with resorbable stitches, while 85% used non-resorbable material for bone flap closure. Forty-four percent used a subgaleal drain. Fifty-five percent of the centers performed ECoG. Thirty-four percent of the center performed an immediately post-operative CT scan; MRI was more often performed later (in 48% of the center after at least 3 months). Sixty-three percent used iodine-based fluids for skin prep, 59% used surgicel for hemosthasis, and 59% of the kids were anesthetized with propofol. Twenty-six percent of the surgeons used autologous grafts for dural replacement; 13% of them never perform dural replacement. 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.