title: Reoperation for refractory epilepsy in childhood: a second chance for selected patients.
abstract: BACKGROUND
  Reoperations account for >10% in pediatric epilepsy surgery cohorts, and they are especially relevant in young children with catastrophic epilepsy.
  
  
  OBJECTIVE
  To determine surgical outcomes and their predictive factors in reoperations for refractory epilepsy in childhood.
  
  
  METHODS
  We retrospectively analyzed presurgical findings, resections, and outcomes of 23 consecutive children who underwent reoperations from 2000 to 2011.
  
  
  RESULTS
  Etiology included cortical dysplasia with/without glioneuronal tumor in 19 patients (83%), sole glioneuronal tumor in 2, and tuberous sclerosis and Rasmussen encephalitis in 1 each. The reasons for the failure of the initial surgery were functional considerations in 8 (35%), incorrect delineation of the epileptogenic zone in 8 (35%), and resection not performed as initially planned in 7 (30%) cases. Final procedures included 8 (35%) intralobar, 8 (35%) multilobar resections, and 7 (30%) hemispherotomies. Following reoperations, 14 (61%) patients were seizure free, 6 (26%) showed significant or worthwhile improvement, and 3 (13%) did not respond to surgery. Six of 8 patients who underwent the first resection before the age of 3 years, 6 of 8 whose first resection was limited by functional considerations, and all 7 with hemispherotomy as the final resection achieved seizure freedom after reoperation.
  
  
  CONCLUSIONS
  Reoperation is particularly beneficial for selected children with refractory epilepsy associated with cortical dysplasia that did not respond to an initial limited and/or early resection but achieved seizure freedom after extensive procedures. When indicated, reoperation should be performed at the youngest possible age to profit from higher functional plasticity in compensating for neurological deficit.
authors.affiliation: *Epilepsy Center, University Hospital Freiburg, Freiburg, Germany; ‡Epilepsy Center Kork, Kehl-Kork, Germany; §Department of General Pediatrics, University Children's Hospital Heidelberg, Germany; ‖Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany; ¶Department of Neuropediatrics and Muscular Disorders, University Children's Hospital Freiburg, Freiburg, Germany; #Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Georgia
authors.initials: G
authors.lastname: Ramantani
authors.forename: Karl
authors.initials: K
authors.lastname: Strobl
authors.forename: Angeliki
authors.initials: A
authors.lastname: Stathi
authors.forename: Armin
authors.initials: A
authors.lastname: Brandt
authors.forename: Susanne
authors.initials: S
authors.lastname: Schubert-Bast
authors.forename: Gert
authors.initials: G
authors.lastname: Wiegand
authors.forename: Rudolf
authors.initials: R
authors.lastname: Korinthenberg
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stephani
authors.forename: Vera
authors.initials: V
authors.lastname: van Velthoven
authors.forename: Josef
authors.initials: J
authors.lastname: Zentner
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
authors.forename: Thomas
authors.initials: T
authors.lastname: Bast
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome