title: Safety of staged epilepsy surgery in children.
abstract: BACKGROUND
  Surgical resection of epileptic foci relies on accurate localization of the epileptogenic zone, often achieved by subdural and depth electrodes. Our epilepsy center has treated selected children with poorly localized medically refractory epilepsy with a staged surgical protocol, with at least 1 phase of invasive monitoring for localization and resection of epileptic foci.
  
  
  OBJECTIVE
  To evaluate the safety of staged surgical treatments for refractory epilepsy among children.
  
  
  METHODS
  Data were retrospectively collected, including surgical details and complications of all patients who underwent invasive monitoring.
  
  
  RESULTS
  A total of 161 children underwent 200 admissions including staged procedures (>1 surgery during 1 hospital admission), and 496 total surgeries. Average age at surgery was 7 years (range, 8 months to 16.5 years). A total of 250 surgeries included resections (and invasive monitoring), and 189 involved electrode placement only. The cumulative total number of surgeries per patient ranged from 2 to 10 (average, 3). The average duration of monitoring was 10 days (range, 1-30). There were no deaths. Follow-up ranged from 1 month to 10 years. Major complications included unexpected new permanent mild neurological deficits (2%/admission), central nervous system or bone flap infections (1.5%/admission), intracranial hemorrhage, cerebrospinal fluid leak, and a retained strip (each 0.5%/admission). Minor complications included bone absorption (5%/admission), positive surveillance sub-/epidural cultures in asymptomatic patients (5.5%/admission), noninfectious fever (5%/admission), and wound complications (3%/admission). Thirty complications necessitated additional surgical treatment.
  
  
  CONCLUSIONS
  Staged epilepsy surgery with invasive electrode monitoring is safe in children with poorly localized medically refractory epilepsy. The rate of major complications is low and appears comparable to that associated with other elective neurosurgical procedures.
authors.affiliation: *Division of Pediatric Neurosurgery, Department of Neurosurgery, ‡The Comprehensive Epilepsy Center, NYU Langone Medical Center, New York University School of Medicine, New York, New York; §Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel; ‖Department of Neurology, The Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Roth
authors.forename: Chad
authors.initials: C
authors.lastname: Carlson
authors.forename: Orrin
authors.initials: O
authors.lastname: Devinsky
authors.forename: David H
authors.initials: DH
authors.lastname: Harter
authors.forename: William S
authors.initials: WS
authors.lastname: Macallister
authors.forename: Howard L
authors.initials: HL
authors.lastname: Weiner
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted / Q000009:adverse effects; D004569:Electroencephalography / Q000009:adverse effects; D004828:Epilepsies, Partial / Q000209:etiology / Q000601:surgery; D004827:Epilepsy / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D064926:Neurophysiological Monitoring / Q000009:adverse effects; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors