Long-term Seizure Outcomes Following Pediatric Epilepsy Surgery in Children with Hemispheric Lesions: Hemispherectomy vs Limited Resections
Abstract number :
1.46
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2023
Submission ID :
1259
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Maksim Parfyonov, MD – Cleveland Clinic
Peter Sarnacki, MD – Cleveland Clinic; Hyunjun Ahn, BS – Cleveland Clinic Lerner College of Medicine; Akshay Sharma, MD – Cleveland Clinic; William Bingaman, MD – Cleveland Clinic; Ahsan Moosa Naduvil Valappil, MD – Cleveland Clinic
Rationale:
Clinicians caring for children with drug resistant epilepsy in the setting of large hemispheric or multilobar lesions are often faced with a difficult surgical decision. Hemispherectomy incurs significant deficits, but has a better chance of seizure freedom. In contrast, smaller lobar/multilobar resections may limit deficits but if unsuccessful lead to multiple surgeries and may prolong time to seizure freedom. This decision becomes especially difficult in patients with minor or no existing deficits. The present study explores the longitudinal seizure outcomes of patients for whom both surgical options were considered.
Methods:
We reviewed the clinical, electroencephalography (EEG), and imaging data of 32 children who underwent epilepsy surgery between 2012 and 2022, for whom both hemispherectomy and a smaller lobar/multilobar resection were discussed as options during the presurgical patient management conference. Seizure outcome data were collected from the medical records at last follow-up. A favorable outcome was defined as complete seizure freedom, discounting any auras or seizures that occurred within the first postoperative week.
Results:
Perioperative complications were not collected. There were no mortalities. At mean follow up of 6.4 years (range 0.5-20), 14 of 32 children (43.8%) were seizure-free (ten hemispherectomy and four limited resection). Re-operation was pursued in 9 of 15 patients (60%) undergoing a smaller first surgery with an additional seven achieving seizure freedom. After a small resection, variables predicting seizure recurrence included presence of residual lesion and acute postoperative seizures after surgery.
Conclusions:
While hemispherectomy has better seizure outcomes overall, favourable seizure outcomes are possible with smaller resective surgeries. We propose that incomplete resection of the lesion contributes to postoperative recurrence after limited resections. This study will assist in better presurgical counseling and candidate selection for patients with large hemispheric or multilobar lesions.
Funding: None
Surgery