Abstracts

Rationale: Penetrating craniocerebral gunshot wounds (GSWs) have a high mortality, leaving survivors with devastating neurological deficits in the majority of cases. Posttraumatic intractable epilepsy is a major health problem in these patients and significantly impacts quality of life and leads to high rates of morbidity. While the surgical management of posttraumatic epilepsy following head trauma has previously been described, epilepsy surgery in patients following GSWs to the head has never before been reported. In this study, we aim to report the evaluation, and surgical treatment strategies used in patients who underwent successful epilepsy resections for medically refractory epilepsy following GSWs to the brain.Methods: A prospectively compiled database of epilepsy patients was used to identify patients that underwent epilepsy surgery for medically refractory epilepsy as a consequence of a prior GSW to the brain. Data regarding the seizure frequency, type of surgical resection and seizure outcomes were compiled.Results: From an epilepsy surgery database of 235 patients, three patients with a prior history of posttraumatic epilepsy following cranio-cerebral GSWs to the head were identified. Ages at surgery were 21, 25, and 27 years old and their GSWs to the head occurred at 18, 13 and 5 years respectively. Seizures began soon after the injury in all patients and became refractory to medications thereafter. All patients had shrapnel fragments intra-cranially and one patient had a prior VNS placed with no improvement in seizure frequency. In two patients, intracranial electrodes were placed for prolonged monitoring. In these patients a partial frontal lobectomy in one and a frontal-parietal resection in the other were performed. One of them underwent an awake craniotomy with language mapping due to the proximity of the seizure foci to language areas. The third patient underwent an orbitofrontal resection. All three patients became seizure free (Engel class Ia) following surgery. Conclusions: Post-traumatic epilepsy is a common sequel of penetrating head injuries. These cases might seem daunting and complex, but intracranial monitoring and surgical resections in these patients can be safely performed and may lead to favorable seizure outcomes. To our knowledge the surgical management of epilepsy following GSWs to the head has never described.