Abstracts

RATIONALE: At the end of this activity the participants should be able to discuss results of resective surgery for epilepsy in children, and relationship of cause and type of surgery. Surgery is a well established treatment for adults with intractable seizures arising from a resectable focus. The available data suggest that children should be considered for surgical evaluation at whatever age they present with intractable focal epilepsy. We present seizure outcome following resective surgery for epilepsy in children.
METHODS: Forty-three patients underwent resective surgery for epilepsy at Hacettepe University Children[ssquote]s Hospital between June 1994 and February 2001. The region for resection was localized by neuroimaging, and scalp EEG/video-EEG. We present the results of remaining 33 patients with a minumum postoperative follow up of 6 months.
RESULTS: Age at the time of surgery was 13 months-18 years (mean: 10.8 years). Nineteen patients were between 1-12 years of age, and 14 patients were between 13-17 years of age. Nineteen patients were boys, and 14 were girls. Fifteen patients underwent temporal resection, 13 patients underwent extratemporal resection, and 5 patients had hemispherectomy. Two patients were lost after hemispherectomy, one within the first 24 hours, other at 10 months. Age at onset of seizures was between 2 days-8 years (mean: 3.4 years) for patients who had temporal resection, 3 days-11 years (mean: 5.1 years) for patients who had extratemporal resection, and 1 month-5 years (mean: 2.2 years) for patients who had hemispherectomy. Postoperative follow up duration ranged between 8 months-6.25 years (mean: 3 years). Neuropathological data showed tumor in 9 patients; 4/9 were diagnosed with dsyembryoplastic neuroepithelial tumor. Eight patients had encephalomalacia, and 6 patients showed temporal gliosis or cyst. Five patients showed neuropathological features of Rasmussen[ssquote]s encephalitis. Infarct, hamartoma, cortical dysplasia, and pial angiomatosis was found, each in one patient. Sixteen patients (52%) were seizure free (class I), 6 patients achieved class II outcome, 9 patients showed class III-IV outcome. 9/15 patients (60%) with temporal resection were seizure free, whereas 6/13 patients (46%) with extratemporal resection, and 2/5 patients (40%) with hemispherectomy were seizure free.
CONCLUSIONS: Available results in pediatric epilepsy surgery series are encouraging, with most patients seizure-free at all ages. In our patients the frequency of good outcome was highest for patients with tumoral cause or temporal localization, in accordance with previous reports. Assessment of risk/benefit ratio, and extensive presurgical evaluation is mandatory.