Seizure Outcomes in Children Following ECoG-Guided Single-Stage Surgical Resection

Publication date: Available online 7 February 2017
Source:Pediatric Neurology
Author(s): Seema Bansal, Andrew J. Kim, Anne T. Berg, Sookyong Koh, Linda C. Laux, Srishti Nangia, John J. Millichap, Alexandra Shaw, Breanne Fisher, Catherine Dezort, Arthur J. DiPatri, Tord D. Alden, Douglas R. Nordli
Background & ObjectiveIn children with abnormal imaging, single-stage epilepsy surgery is an attractive alternative to the two-stage approach that relies on invasive recording of seizures. Implanted electrodes carry risks of their own and extend hospitalization, but the efficacy of one-stage resections in a variety of pathologies and cerebral locations is not well established. We report our center's experience with single-stage epilepsy surgery guided by intraoperative electrocorticography (ECoG).MethodsWe retrospectively analyzed 130 consecutive patients who underwent single-stage epilepsy surgery before age 19 years and had at least 2-year follow up. Intraoperative ECoG was available for review in 113. Patients were considered seizure-free if they were continuously Engel Class I up to the 2-year postoperative mark. ECoG findings were classified according to the presence of interictal attenuation, spikes, both, or neither. Complications and hospital length of stay were evaluated.ResultsEighty percent of 130 patients were seizure-free at 2-years. All but one had abnormal MRI. Tumor patients had better seizure outcome than cortical malformation patients. Frontal resections had worse outcome, especially among tumors. Intraoperative ECoG revealed both attenuation and spikes in 48%, attenuation only in 23%, spikes only in 20%, and neither in 9%. Complication rate was 6.9% with no major neurologic complications. Average length of stay was 5.7 nights.ConclusionsWith ECoG-guided single-stage surgery, we achieved results comparable to other pediatric surgical series and with low complication rate. Extensive two-stage approach may not be required when there is a lesion on imaging and other information is concordant, even when the MRI abnormality is subtle and unclearly delineated. Frontal foci may present a challenge due of their proximity to "eloquent" nonresectable cortex or critical structures.



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