title: Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web-based survey by the ILAE Task Force on Pediatric Epilepsy Surgery.
abstract: Surgical techniques may vary extensively between centers. We report on a web-based survey aimed at evaluating the current technical approaches in different centers around the world performing epilepsy surgery in children. The intention of the survey was to establish technical standards. A request was made to 88 centers to complete a web-based survey comprising 51 questions. There were 14 questions related to general issues, 13 questions investigating the different technical aspects for children undergoing epilepsy surgery, and 24 questions investigating surgical strategies in pediatric epilepsy surgery. Fifty-two centers covering a wide geographic representation completed the questionnaire. The median number of resective procedures per center per year was 47. Some important technical practices appeared (>80% of the responses) such as the use of prophylactic antibiotics (98%), the use of high-speed drills for bone opening (88%), nonresorbable material for bone flap closure (85%), head fixation (90%), use of the surgical microscope (100%), and of free bone flaps. Other questions, such as the use of drains, electrocorticography (ECoG) and preoperative withdrawal of valproate, led to mixed, inconclusive results. Complications were noted in 3.8% of the patients submitted to cortical resection, 9.9% hemispheric surgery, 5% callosotomy, 1.8% depth electrode implantation, 5.9% subdural grids implantation, 11.9% hypothalamic hamartoma resection, 0.9% vagus nerve stimulation (VNS), and 0.5% deep brain stimulation. There were no major differences across regions or countries in any of the subitems above. The present data offer the first overview of the technical aspects of pediatric epilepsy surgery worldwide. Surprisingly, there seem to be more similarities than differences. That aside many of the evaluated issues should be examined by adequately designed multicenter randomized controlled trials (RCTs). Further knowledge on these technical issues might lead to increased standardization and lower costs in the future, as well as definitive practice guidelines.
authors.affiliation: Department of Neurosurgery, ABC Faculty of Medicine, Sao Paulo, Brazil.
authors.forename: Arthur
authors.initials: A
authors.lastname: Cukiert
authors.affiliation: Institute of Neuroscience and Physiology, Sahlgrenska Academy of Gothenburg University, Gothenburg, Sweden.|Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Rydenhag
authors.affiliation: Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Harkness
authors.affiliation: UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.|Young Epilepsy, Lingfield, United Kingdom.
authors.forename: J Helen
authors.initials: JH
authors.lastname: Cross
authors.affiliation: Center for Neuroscience and Behavioral Health, Children's National Health System, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, U.S.A.
authors.forename: William D
authors.initials: WD
authors.lastname: Gaillard
mesh_terms: D026683:Advisory Committees; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003337:Corpus Callosum; D003399:Craniotomy / Q000295:instrumentation; D046690:Deep Brain Stimulation; D000069280:Electrocorticography / Q000379:methods; D004567:Electrodes, Implanted; D004827:Epilepsy / Q000209:etiology / Q000601:surgery*; D006222:Hamartoma / Q000150:complications / Q000601:surgery; D006801:Humans; D007027:Hypothalamic Diseases / Q000150:complications / Q000601:surgery; D007223:Infant; D038622:Internationality; D020407:Internet; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019919:Prosthesis Implantation / Q000379:methods*; D013523:Surgical Equipment; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D055536:Vagus Nerve Stimulation
keywords: Epilepsy; Pediatric; Surgery; Survey; Technique