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 specific surgical issues. Methods: A web-based survey comprising 13 questions was filled up by 52 centers representing all continents. Questions investigated the different technical aspects for kids undergoing temporal lobe resection, hemispherectomy or callosotomy. These included: positioning, peroperative imaging, peroperative neurophysiology, surgical instruments, skin incision, bone flap, and surgical extension. Complication rates and types were evaluated for all types of surgical procedures. Results: Regarding temporal lobe resections, 90% of the surgeons used head fixation, 61% image guidance, 67% ultrasonic aspiration, 50% electrocorticography; all used the surgical microscope. Sixty-six percent of the surgeons used a question-mark skin incision, and 82% used free bone flaps. While performing callosotomy, 80% of the surgeons used a supine, neck-flexed position, 34% used U-shaped skin incisions, 76% put bone flaps over the midline, 80% used bipolar coagulation for the callosal section itself and 46% used neuronavigation. In hemispheric surgery, 63% used ultrasound aspiration, 58% used the microscope only, 38% used both the loupe and the microscope, 53% performed insular resection, 32% performed insular disconnection, 25% performed basal ganglia disconnection, 44% used a question mark skin incision, and 76% used a free bone flap. 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.