title: Microscopic and macroscopic infarct complicating pediatric epilepsy surgery.
abstract: There is some suggestion that microscopic infarct could be associated with invasive monitoring, but it is unclear if the microscopic infarct is also visible on imaging and associated with neurologic deficits. The aims of this study were to assess the rates of microscopic and macroscopic infarct and other major complications of pediatric epilepsy surgery, and to determine if these complications were higher following invasive monitoring.
  
  
  
  We reviewed the epilepsy surgery data from a tertiary pediatric center, and collected data on microscopic infarct on histology and macroscopic infarct on postoperative computed tomography (CT) or magnetic resonance imaging (MRI) done one day after surgery and major complications.
  
  
  
  Three hundred fifty-two patients underwent surgical resection and there was one death. Forty-two percent had invasive monitoring. Thirty patients (9%) had microscopic infarct. Univariable analyses showed that microscopic infarct was higher among patients with invasive monitoring relative to no invasive monitoring (20% vs. 0.5%, respectively, p < 0.001). Eighteen patients (5%) had macroscopic infarct on CT or MRI. Univariable analysis showed no significant difference in macroscopic infarct between invasive monitoring and no invasive monitoring (8% vs. 3%, respectively, p = 0.085). One patient with microscopic infarct had transient right hemiparesis, and two with both macroscopic and microscopic infarct had unexpected persistent neurologic deficits. Thirty-two major complications (9.1%) were reported, with no difference in major complications between invasive monitoring and no invasive monitoring (10% vs. 7%, p = 0.446). In the multivariable analysis, invasive monitoring increased the odds of microscopic infarct (odds ratio [OR] 15.87, p = 0.009), but not macroscopic infarct (OR 2.6, p = 0.173) or major complications (OR 1.4, p = 0.500), after adjusting for age at surgery, sex, age at seizure onset, operative type, and operative location.
  
  
  
  Microscopic infarct was associated with invasive monitoring, and none of the patients had permanent neurologic deficits. Macroscopic infarct was not associated with invasive monitoring, and two patients with macroscopic infarct had persistent neurologic deficits.
authors.affiliation: Neuroscience and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Rubinger
authors.affiliation: Department of Pathology, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Lili-Naz
authors.initials: LN
authors.lastname: Hazrati
authors.affiliation: Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Raheel
authors.initials: R
authors.lastname: Ahmed
authors.affiliation: Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Rutka
authors.affiliation: Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Carter
authors.initials: C
authors.lastname: Snead
authors.affiliation: Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.|Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Elysa
authors.initials: E
authors.lastname: Widjaja
mesh_terms: D000293:Adolescent; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000209:etiology*; D002648:Child; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Complications; Infarct; Invasive monitoring; Microscopic infarct; Pediatric epilepsy surgery