Approach In Pediatric Population Research Articles

Low-grade epilepsy-associated tumors: Epilepsy outcome and antiseizure medication discontinuation after lesionectomies as first-line surgical approach in pediatric population.

This study aimed to evaluate epilepsy outcome and antiseizure medication (ASM) discontinuation after lesionectomies as first surgical approach in pediatric population diagnosed with low-grade epilepsy-associated neuroepithelial tumors (LEATs). We conducted a retrospective study. Thirty-six consecutive patients with histological diagnoses of LEATs who underwent surgery between 2018 and 2021 at our institution were included. The clinical and surgical data were retrospectively analyzed. Thirty (83.3%) of 36 patients are free of disabling seizures (Engel class I) and 19 (63,4%) of them are classified as Engel Ia. In 17 (47.2%) patients, ASM could be discontinued. The mean age at surgery was 8.6 years (±4.04) and the mean age at onset of epilepsy was 7.2 years (±3.8), whereas the mean duration of epilepsy in months at the time of surgery was 21.3 months (±23.7). The epileptogenic tumor was in the temporal lobe in 20 (55.5%) patients. Because of seizure persistence, a second or a third surgery was necessary for six patients (16.7%) and four of them had residual lesions (three in temporal and one in extratemporal site). No perioperative complications were recorded, including acute seizures, with a median hospitalization time of 7 days. Shorter epilepsy duration at time of surgery as long as a single ASM was significantly correlated with an Engel class I outcome (p-value = .01 and p-value = .016, respectively). Focal seizure semeiology was associated with an increased probability of antiseizure medication discontinuation (p-value = .042). Our findings confirm that shorter epilepsy disease duration, monotherapy before surgery, and seizure semeiology are determinant factors for a positive seizure outcome and medication discontinuation, also with less invasive surgical approaches such as lesionectomies. However, considering the intrinsic multifactorial epileptogenic nature of LEATs, a tailored surgical approach should be considered to optimize clinical and seizure outcome, especially for lesions located in the temporal lobe.

Endonasal Endoscopic Approach in Management of Paediatric CSF Rhinorrhoea Cases

Though endoscopic repair has been the proven to be the gold standard for the repair of cerebrospinal fluid rhinorrhoea in adult patients, the type of approach to be used in paediatric patients especially those below 5years is still a challenge with no clear cut guidelines. The objective of this study was to evaluate the efficacy of using endonasal endoscopic approach for treating paediatric patients aged less than 5years diagnosed with cerebrospinal fluid rhinorrhoea. This was a retrospective analysis of five cases of paediatric CSF rhinorrhoea operated in a tertiary health care centre with an age of less than 5years from October 2002 to September 2010. All the five cases treated by endoscopic approach have no further complaints of CSF leak or meningitis with a follow up period of a minimum period of 6months. Two cases were further detected to have meningocele and meningoencephalocele which was detected preoperatively and treated by reduction and excision respectively. The good results obtained by endoscopic closure with lack of major complications and the decreased morbidity for the patient suggests that the endoscopic approach should be considered the first line of approach in pediatric population. But we would warrant a careful selection procedure and availability of adequate expertise for this approach to avoid complications.