Pre-surgical evaluation and surgical treatment in children with extratemporal epilepsy.
BACKGROUND
This review summarizes some patterns of pre-surgical evaluation and surgical treatment of extratemporal epilepsy in pediatric patients with medically refractory seizures, whose ictal behavior is variable. The most effective treatment for intractable partial epilepsy is a focal cortical resection with excision of the epileptogenic zone (the area of ictal onset and initial seizure propagation). This might be risky, though, in the case of a widespread lesion, sometimes encroaching one or more lobes, given the risk to the functional cerebral cortex. An anterior temporal lobectomy might prove more effective then in preventing seizures with fewer potential complications. If partial extratemporal epilepsy is associated with pharmaco-resistant seizures, the preoperative evaluation and operative strategy are determined according to the epileptogenic zone and to the relationship between a substrate-directed disorder and eloquent areas. The pediatric treatment of extratemporal epilepsy is aimed at controlling the seizures, avoiding morbidity, and improving the patient's quality of life through psychosocial integration. Since the immature brain is more plastic than when mature, the recovery of functions after surgery is greater in children than in adults.


CONCLUSIONS
Early surgery is recommended for children with intractable epilepsy, and is now accepted as an important therapeutic modality also for children with chronic epilepsy.


CONCLUSIONS
Technological advances in the last two decades, mainly in neuroimaging, have led many medical centers to consider surgical treatment of epilepsy, accuracy being granted by MRI-based neuronavigation systems-an interface between the lesion seen in the preoperative magnetic resonance imaging (MRI) and the operative field, often invisible to the surgeon.
Centeno
Ricardo Silva
RS
Universidade Federal de São Paulo, Departamento de Neurologia/Neurocirurgia, Disciplina de Neurocirurgia. Rua Napoleão de Barros, 715-6 andar Vila Clementino 04024-002, São Paulo, SP, Brazil.
Yacubian
Elza Marcia
EM
Sakamoto
Americo Ceiki
AC
Ferraz
Antonio Fernando Patriani
AF
Junior
Henrique Carrete
HC
Cavalheiro
Sergio
S
D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D010372:Pediatrics; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome