title: Safety, feasibility and complications during resective pediatric epilepsy surgery: a retrospective analysis.
abstract: BACKGROUND
  Resective epilepsy surgery is an established and effective method to reduce seizure burden in drug-resistant epilepsy. It was the objective of this study to assess intraoperative blood loss, transfusion requirements and the degree of hypothermia of pediatric epilepsy surgery in our center.
  
  
  METHODS
  Patients were identified by our epilepsy surgery database, and data were collected via retrospective chart review over the past 25 years. Patients up to the age of 6 years were included, and patients with insufficient data were excluded.
  
  
  RESULTS
  Forty-five patients with an age of 3.2 ± 1.6 (mean ± SD) years and a body weight of 17 [14; 21.5] kg (median [25%, 75% percentile]) were analysed. Duration of surgery was 3 h 49 min ± 53 min, which was accompanied by an intraoperative blood loss of 150 [90; 300] ml. This corresponded to 11.7 [5.2; 21.4] % of estimated total blood volume, ranging from 0 to 75%. A minimal haemoglobin count of 8.8 ± 1.4 g/dl was measured, which was substituted with erythrocyte concentrate (100 [0; 250] ml) in 23 patients. Body core temperature dropped from 36.0 ± 0.7°C at baseline to a minimum of 35.7 ± 0.7°C, and increased significantly (p < 0.001) thereafter to 37.1 ± 0.7°C until the end of surgery. A significant (p = 0.0003) correlation between duration of surgery and blood loss (Pearson r = 0.52) was observed. However, age, minimal body temperature or number of antiepileptic drugs seemed to have no impact on blood loss.
  
  
  CONCLUSIONS
  Resective epilepsy surgery is a safe procedure even in the pediatric population, however it is associated with significant blood loss especially during long surgical procedures.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
authors.forename: Marcus O
authors.initials: MO
authors.lastname: Thudium
authors.affiliation: Department of Neurosurgery, University of Bochum, Knappschaftskrankenhaus, In der Schornau 23-25, 44892 Bochum, Germany.
authors.forename: Marec
authors.initials: M
authors.lastname: von Lehe
authors.affiliation: Department of Neurosurgery, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Wessling
authors.affiliation: Department of Pediatrics, University of Freiburg Medical Center, Heiliggeiststraße 1, 79106 Freiburg im Breisgau, Germany.
authors.forename: Jan-Christoph
authors.initials: JC
authors.lastname: Schoene-Bake
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Soehle
mesh_terms: D016063:Blood Loss, Surgical; D001831:Body Temperature; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Epilepsy surgery; Neuroanesthesia; Pediatric neuroanesthesia; Pediatric neurosurgery