Invasive monitoring after resection of epileptogenic neocortical lesions in multistaged epilepsy surgery in children
| Autor: | Sophie Phillips, Crystalann Rodriguez, Neel Patel, Cordelia Orillac, Orrin Devinsky, Eveline Teresa Hidalgo, Howard L. Weiner, Daniel Friedman, Hyman Gregory Frankel |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Reoperation Drug Resistant Epilepsy medicine.medical_specialty Neocortex Neurosurgical Procedures 03 medical and health sciences Tuberous sclerosis Epilepsy Postoperative Complications 0302 clinical medicine Tuberous Sclerosis medicine Humans Epilepsy surgery Ictal Child Retrospective Studies Subclinical infection Postoperative Care business.industry Cortical dysplasia medicine.disease Neurophysiological Monitoring Surgery Treatment Outcome Neurology Gliosis Child Preschool 030220 oncology & carcinogenesis Female Histopathology Epilepsies Partial Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Epilepsy Research. 148:48-54 |
| ISSN: | 0920-1211 |
| DOI: | 10.1016/j.eplepsyres.2018.09.001 |
| Popis: | Objective Incomplete resection of neocortical epileptogenic foci correlates with failed epilepsy surgery in children. We often treat patients with neocortical epilepsy with a staged approach using invasive monitoring to localize the focus, resect the seizure onset zone, and, in select cases, post-resection invasive monitoring (PRM). We report the technique and the outcomes of children treated with staged surgery including PRM. Methods We retrospectively reviewed the charts of pediatric patients with neocortical epilepsy who underwent resective surgery with PRM. Results We identified 71 patients, 5 patients with MRI-negative epilepsy and 66 patients with MRI-identified neocortical lesions; 64/66 (97%) patients had complete lesionectomy. In 61/71 (86%) patients PRM was associated with positive outcomes. Those findings were: 1) clinical seizures with electrographic involvement at resection margins (47%); 2) subclinical seizures and interictal discharges at resection margins (29%); and 3) clinical and subclinical seizures revealing a new epileptogenic focus (20%). In 55/71 (77%) patients, PRM data led to additional resection (re-resection; RR). Six additional patients had no further resection due to overlap with eloquent cortex. Histopathology showed tuberous sclerosis complex (TSC; n = 46), focal cortical dysplasia (FCD; n = 16)), gliosis (n = 4), tumors (n = 4), and Sturge-Weber syndrome (n = 1). There were no major complications. Seizure-free outcome in children with TSC was 63% at 1-year follow-up and 56% at 2-year follow-up. In FCD, seizure freedom after 1 and 2 years was 85%. Significance Post-resection monitoring may provide additional information about the extent of the epileptogenic zone, such as residual epileptogenic activity at the margins of the resection cavity, and may unmask additional seizure foci. This method may be especially useful in achieving long-term stable seizure-free outcome. |
| Databáze: | OpenAIRE |
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