Pediatric Neuropsychological Outcomes in LITT vs Open Resection
Abstract number :
3.312
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2023
Submission ID :
915
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Madison Berl, PhD – Children's National Hospital
Allyson Alexander, MD – Children's Colorado; Krista Eschbach, MD – Children's Colorado; Chloe Hooker, BS – Children's National Hosptial; Donald Bearden, PhD – Children's Hospital of Atlanta; Greta Wilkening, PsyD – Children's Colorado
Rationale: Utilization of laser interstitial thermal therapy (LITT) has increased in pediatric epilepsy patients. While medical outcomes between LITT and traditional open resection approaches are reported, there is little information regarding neuropsychological outcomes. This study compares pre and post surgical neuropsychological functioning outcomes between the two approaches using the Pediatric Epilepsy Research Consortium (PERC) Surgery Database of twenty sites.
Methods: A total of 673 patients with epilepsy ranging in age from 0 to 25 years (mean age at surgery 11.2 years) underwent a neurosurgical procedure (20.8% LITT; 44.3% lesionectomy; 30.6% lobectomy; 4.3% multilobar). Of those, 272 (40.4%) had neuropsychological evaluation (118 pre and post; 145 only presurgical; 9 only postsurgical) across intellectual, adaptive, memory, psychosocial, processing speed, and language domains. We examined if children who received neuropsychological testing differed from those that did not. Of those that had neuropsychological testing and surgery, we compared demographic and medical characteristics, and if pre and post operative neuropsychological performance differed by surgical procedure using appropriate parametric or nonparametric statistics.
Results: The youth who went to surgery and did not have neuropsychological testing had younger mean age onset of seizure (5.3 vs 7.0 years); younger mean age at surgery (10.7 vs 12.9); and more often underwent palliative procedures (21.2% vs 12.9%; [p’s < .05]). Of the youth that had surgery and neuropsychological evaluation, those that underwent LITT compared to open resection had significantly different MRI’s compared to the open resection surgery group (more nonlesional or acquired), more midline/bilateral hemisphere, more hypothalamic, and less frequent multi-lobar procedures. Surgical outcome was significantly different such that participants who underwent an open resection had greater seizure freedom (71% vs 46%) at followup. There were no overall differences in pre- or post-surgical neuropsychological functioning across any domain regardless if seizure freedom was achieved. Average follow up testing was 12 months ranging from 2 weeks to 41 months.
Surgery