Focal cortical resections for the treatment of extratemporal epilepsies in children

Abstract

Children with lesion-related extratemporal epilepsies with suboptimal seizure control should be identified early and referred for presurgical evaluation before irreversible deterioration in cognitive or psychosocial functions ensues due to long-standing disabling seizures and chronic antiepileptic drug-related side effects. The success of epilepsy surgery depends upon the accurate preoperative localization of the epileptogenic zone and its complete resection. Children with medically refractory lesional epilepsies belong to different categories depending upon the degree of complexity involved in the presurgical evaluation to define their epileptogenic zone. While some patients, such as those with tumoral epilepsy syndrome, can be selected for surgery by simple noninvasive presurgical evaluation strategy, others with malformations of cortical development and those with multiple lesions often require complex and invasive means to define their epileptogenic zone. Recent advances in structural and functional imaging have obviated the need of invasive monitoring in the majority. These advances along with improvement in surgical techniques have made resective surgery safer and more effective. Prospective comprehensive follow-up studies are needed to evaluate the long-term seizure, cognitive, psychosocial, educational and occupational outcomes of surgically treated children with extratemporal epilepsies.