Defining the spectrum of international practice in pediatric epilepsy surgery patients

Inequities in access to pediatric epilepsy surgery: a bioethical framework

“…In an international survey of pediatric epilepsy surgery centers, the mean duration of the disorder before surgery was 5.7 years, with significantly longer mean times for older children. 13 More importantly, this study also found that only a minority of children at greatest risk of epileptic encephalopathy received time-appropriate surgery. Particular patient populations at risk include children with refractory infant-onset epilepsies, in whom early surgical intervention has been shown to mitigate the detrimental effects of seizures on brain development.…”

“…The implementation of palliative surgical strategies is however highly discrepant between centers. 13 Another subgroup comprises children with severe developmental delay. Epilepsy surgery pioneers Falconer 10 and Rasmussen 28 initially considered developmental delay to be a contraindication to epilepsy surgery; however, current practice guidelines do not discriminate against children with developmental delay, because this does not predict seizure outcome.…”

Neurosurgical Management of Intractable Temporal Lobe Epilepsy by Amygdalohippocampectomy Plus Anterior Temporal Lobectomy: Report of Initial Three Pediatric Cases with Short Literature Review

“…Common causes of intractable surgical epilepsy in childhood is cortical dysplasia, MTS, temporal lobe and other lobe tumors(DNET, ganglioglioma and others),cortical atrophy, stroke, trauma, vascular lesion(AVM, cavernoma )etc. 1,2,3 In case-1 the patient was suffering from intractable TLE. Imaging confirmed a epileptogenic lesion in the amygdala and hippocampal area which was a low grade ganglioglioma.…”

“…Low grade ganglioglioma is one of the common benign lesion in this area causing TLE specialy in children for which surgery is needed. 3 Appropiate surgical intervention is usually curative.…”

“…Literature suggests that in most of the cases surgery is curative if there is no second focus or at least good control of epilepsy can be achieved with AED. 2,3 We went for amygdalohippocampectomy with plus standard anterior temporal lobectomy in two cases and amygdalohippocampectomy with plus standard anterior temporal lobectomy with excision of arachnoid cyst in one case but selective amygdalohippocampectomy (with lesionectomy where applicable) could be another surgical option to these lesions 2 . Size of the lesion, possibility of different pathology, narrow space through trans-sylvian route and possibility of manipulation and damage of critical vessels and neural structures and most importantly less familiarity of the approach along with less success rate of amygdalohippocampectomy in controlling epilepsy helped us to take decision in favour of trans middle temporal gyrus approach amygdalohippocampectomy with lesionectomy plus standard anterior temporal lobectomy instead of selective amygdalohippocampectomy in the hope to cure epilepsy as well as the lesion.…”