197 A Multidisciplinary Approach to Posterior Quadrant Disconnective Epilepsy Surgery in Pediatric Patients

Abstract

INTRODUCTION: Extensive lesions of the posterior quadrant are a relevant cause of pediatric drug-resistant epilepsy. Early surgery is the best treatment in these cases but conventional multilobar resections carry a significant risk in pediatric patients. Despite temporo-parieto-occipital (TPO) disconnection being the preferable technique due to the preservation of motor function, studies reporting long-term longitudinal outcomes are still limited. METHODS: A prospective analysis was carried out on 12 children who underwent TPO disconnection. (Image 1 and 2) RESULTS: TPO disconnection was performed in 12 pediatric patients aged between 14 months and 18 years (median 6.29 years). The average age of seizure onset was 0.97±1.22 years. Causes of TPO included perinatal ischemia in 4 and malformation of cortical development (MCD) in 8. The presenting seizure types were focal motor impaired awareness seizures in 7 children and generalized in 5. The affected hemisphere was the right one in 9 patients and the left in 3. In half of the patients the temporal approach was performed through T1 and in the other 50% through T2. After neuropsychological examination, 2 children improved, 7 remained stable, 2 patients presented stagnation and 1 declined. Regarding postoperative complications, a non-resorptive hydrocephalus and an asymptomatic caudate nucleus infarct were observed. After a median follow-up of 2 years, 9 patients were in Engel’s Class I seizure outcome. CONCLUSIONS: TPO disconnection is a safe and effective motor-sparing epilepsy surgery for children with refractory seizures located in the posterior quadrant, which prevents further cognitive deterioration.