Authors :
Presenting Author: Nicholas Benjamin, MD – Children's Hospital of Pittsburgh, UPMC
Brady Grano-Mickelsen, JD, MBA, BA – Children's Hospital of Pittsburgh, UPMC
Leen Alkalbani, MD – Children's Hospital of Pittsburgh, UPMC
Geetha Vasudevan, MD – Children's Hospital of Pittsburgh, UPMC
Himadri Patel, MD – Children's Hospital of Pittsburgh, UPMC
Mikaela Speakes, MD – Children's Hospital of Pittsburgh, UPMC
Taylor Abel, MD – Children's Hospital of Pittsburgh, UPMC
William Welch, MD – Children's Hospital of Pittsburgh, UPMC
Ruba Al-Ramadhani, MD – Children's Hospital of Pittsburgh, UPMC
Rationale:
Surgical resection of neuro-oncologic tumors is a cornerstone of treatment for pediatric patients with drug-resistant epilepsy. However, data specifically examining the role of stereoelectroencephalography (sEEG) prior to tumor resection within this population remains limited. This study aims to describe the clinical characteristics and post-surgical seizure outcomes of pediatric patients who underwent sEEG-guided resection of neuro-oncologic tumors at a single tertiary care center.
Methods:
Data was retrospectively collected from a centralized sEEG patient database at the UPMC Children's Hospital. Patients with confirmed neuro-oncologic pathology who underwent sEEG prior to tumor resection or re-resection were identified and included. Clinical characteristics, sEEG parameters, surgical details, and seizure outcomes were compiled and presented in a case-series format.
Results:
See Table 1 for further results. Nine patients met inclusion criteria. The mean age of epilepsy onset was 5.5 years (range: 1.5–16 years), with the mean age of sEEG placement being 15.5 years (range: 7–22 years). The median duration from seizure onset to sEEG placement was 5 years, and patients had been trialed on an average of 4 anti-seizure medications (ASMs) pre-surgically. Unilateral sEEG was performed in 7 patients (78%), with an average of 9 electrodes placed per patient. Temporal lobe localization was identified in 4 patients (44%). Two patients underwent RNS placement, and two others had VNS trials.
All patients underwent tumor resection: 5 had glial tumors (56%) and 3 had mixed neuroglial pathology (33%). sEEG preceded initial resection in 5 patients (56%) and preceded re-resection in the other 4 patients (44%). Post-surgically, the average number of maintenance ASMs was 1.2. At last follow-up, 5 patients (56%) reported seizure freedom (Engel Class I), and 8 patients (89%) reported meaningful seizure improvement (Engel Class I–III). Only one patient reported no clinical benefit (Engel Class IV).
Conclusions:
This case-series details the clinical profiles and post-surgical outcomes of pediatric patients who underwent sEEG prior to resection of neuro-oncologic tumors. Most patients had either glial or mixed neuroglial tumors, and over half of the cohort endorsed seizure freedom post-operatively. However, the percent of patients endorsing seizure freedom in this cohort was less than typically expected following tumor resection. This difference is likely attributable to the increased clinical complexity in this cohort, which necessitated sEEG placement in the first place prior to surgery, as sEEG is only performed when required (i.e. simple tumors do not require sEEG prior to resection).
The vast majority did endorse clinical improvement in seizure burden, along with the majority being on decreased amounts of ASMs. These findings suggest that the use of sEEG in surgical planning for clinically complex tumor-related epilepsy in pediatric patients may have significant benefit when discussing seizure burden. Multicenter studies with larger cohorts are needed to investigate factors associated with favorable seizure outcomes, along with comparing sEEG vs non-sEEG guided tumor removal.
Funding: N/a