gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

Risk and benefit of resective epilepsy surgery in the first years of life

Meeting Abstract

  • Caroline Meyer - Klinik für Neurochirurgie, Universiktätsklinikum Bonn
  • Christoph Schoene-Bake - Klinik für Epileptologie, Universiktätsklinikum Bonn
  • Robert Sassen - Klinik für Epileptologie, Universiktätsklinikum Bonn
  • Stefan Kuczaty - Klinik für Epileptologie, Universiktätsklinikum Bonn
  • Marec von Lehe - Klinik für Neurochirurgie, Universiktätsklinikum Bonn

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.15.04

doi: 10.3205/13dgnc409, urn:nbn:de:0183-13dgnc4090

Veröffentlicht: 21. Mai 2013

© 2013 Meyer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: Resective surgery in children is an established method to treat drug-resistant epilepsy. Our goal was to determine risk and benefit of this invasive treatment option in very young children.

Method: We retrospectively analyzed data of 49 children who underwent surgery up to the age of 72 months. We excluded disconnective procedures (hemispherotomy, callosotomy). Long-term follow-up (FU) was assessed either by clinical records or routine FU telephone interviews.

Results: Mean age at seizure onset was 19 months. Noninvasive EEG showed focal epileptic discharges (69%), both generalized and focal ETPs (19%) and only generalized ETPs (12%). Invasive EEG recording was done in 10%. Preoperative MRI suspected mostly dysplasias. Mean age at surgery was 45 months. Localization was extratemporal in 41.2%, temporo-mesial in 27.5%, multilobar in 21.6 and temporal but not mesial in 9.8%. Most common histological findings were dysplasias (54%), tumors (36%) and hippocampal-sclerosis (6%). Tumors were graded WHO°I except one ganglioglioma WHO°II. Three patients had a new permanent deficit: One patient with occipital lesion suffered from hemianopia as calculated deficit; one patient had a hemiparesis, one a hemianopia where a quadrantanopia was expected (permanent unexpected morbidity 4.1%). There was no mortality. After a mean FU of 7.7 years (range 1–23yrs) 73.5% were completely seizure free at last FU (ILAE 1) and 30.2% of these were without antiepileptic drugs. 12% showed marked improvement (ILAE 2–4). A circumscribed lesion in preoperative MRI shows a tendency towards better epilepsy-control. Presurgical generalized EEG was not associated with a worse outcome. There were no other significant correlations between potentially predictive factors (age at onset, age at surgery, duration of seizures, histology) and seizure outcome.

Conclusions: Despite the higher level of uncertainty in pre-surgical work-up and presumably higher rate of peri-operative complications, epilepsy-surgery in very young children is a safe and effective treatment option that renders approximately 3/4 of patients seizure free.