Few data are available concerning efficacy and safety of surgery for catastrophic epilepsy in the first 6 months of life.
The authors retrospectively analyzed epilepsy surgeries in 15 infants ranging in age from 1.5 to 6 months (median 4 months) and weight from 4 to 10 kg (median 7 kg) who underwent anatomical (4 patients) or functional (7 patients) hemispherectomy, or frontal (1 patient), frontoparietal (2 patients), or parietooccipital (1 patient) resection for life-threatening catastrophic epilepsy due to malformation of cortical development.
No patient died. Intraoperative complications included an acute ischemic infarction with hemiparesis in our youngest, smallest infant. The most frequent complication was blood loss requiring transfusion, which was encountered in every case. The estimated blood loss was 3–214% (median 63%) of the total blood volume. At maximum follow-up of 6–121 months (median 60 months), 46% were seizure free.
Epilepsy surgery may be effective in young infants as it is in older children. However, intraoperative blood loss and risk of permanent postoperative neurological deficits present significant challenges.
Abbreviations used in this paper: EEG = electroencephalography; ICU = intensive care unit; LOS = length of stay; MCA = middle cerebral artery; MCD = malformation of cortical development; TSC = tuberous sclerosis complex.
ViningEPFreemanJMPillasDJUematsuSCarsonBSBrandtJ: Why would you remove half a brain? The outcome of 58 children after hemispherectomy—the Johns Hopkins experience: 1968 to 1996. Pediatrics100:163–1711997