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George M. Ibrahim, Benjamin W. Barry, Aria Fallah, O. Carter Snead III, James M. Drake, James T. Rutka, and Mark Bernstein

guidelines has been proposed for pediatric patients, 6 many children continue to face barriers in access to surgical interventions. In an international survey of pediatric epilepsy surgery centers, the mean duration of the disorder before surgery was 5.7 years, with significantly longer mean times for older children. 13 More importantly, this study also found that only a minority of children at greatest risk of epileptic encephalopathy received time-appropriate surgery. Particular patient populations at risk include children with refractory infant-onset epilepsies, in

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Recent advances in the neurosurgical treatment of pediatric epilepsy

JNSPG 75th Anniversary Invited Review Article

Jarod L. Roland and Matthew D. Smyth

D espite the development of several new antiepileptic drugs (AEDs) over the last 30 years, there has been little change in the overall effectiveness of the treatment of epilepsy with medication. 11 However, there have been numerous advances in the neurosurgical treatment of epilepsy that have expanded treatment options for patients and reduced morbidity via less-invasive procedures. Herein we review some of the most recent advances and trends in the neurosurgical treatment of pediatric epilepsy. Expanding the Evidence in Support of Epilepsy Surgery Before

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Benoit Jenny, Nicolas Smoll, Yassine El Hassani, Shahan Momjian, Claudio Pollo, Christian M. Korff, Margitta Seeck, and Karl Schaller

an intraparenchymatous hemorrhage that became symptomatic 48 hours after hemispherotomy for hemimegalencephaly in a child of 10 months. These cases are known to be the most challenging for pediatric epilepsy neurosurgeons. 12 , 13 In this particular case, venous bleeding through the whole surgery combined with an extremely narrowed surgical corridor to the deep brain structures led to disturbance of the clotting profile despite adequate transfusion of red cells and coagulation factors. Closure went uneventfully, but 2 days after surgery the conscious state of the

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Pongkiat Kankirawatana, Ismail S. Mohamed, Jason Lauer, Inmaculada Aban, Hyunmi Kim, Rong Li, Allan Harrison, AS, Monisha Goyal, Curtis J. Rozzelle, Robert Knowlton, and Jeffrey P. Blount

contribution and prognostic capability of each imaging modality utilized at our center in predicting seizure freedom after pediatric epilepsy surgery. Methods Cohort and Definitions Patients who underwent epilepsy surgery at Children’s of Alabama between December 2003 and June 2016 were identified in our prospectively maintained pediatric epilepsy surgery database. We excluded patients who had less than 2 years of follow-up and those who underwent functional hemispherectomy or vagus nerve stimulation device implantation. The duration of epilepsy was stratified at 60 months

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Gabriel Crevier-Sorbo, Tristan Brunette-Clément, Edgard Medawar, Francois Mathieu, Benjamin R. Morgan, Laureen D. Hachem, Michael C. Dewan, Aria Fallah, Alexander G. Weil, and George M. Ibrahim

performed in LMICs with high rates of seizure freedom. 25 Given the facts that 1) children constitute the population most affected by epilepsy in Haiti, 2) effective epilepsy surgery is both desirable and feasible in a low-resource setting, and 3) Haiti continues to invest and expand its pediatric neurosurgery infrastructure, we sought to estimate the need for pediatric epilepsy surgery in Haiti. We recently reported on the current state of the assessment and medical treatment of epilepsy in Haiti through a comprehensive chart review of all children treated from 2008

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Ji Hoon Phi, Byung-Kyu Cho, Kyu-Chang Wang, Ji Yeoun Lee, Yong Seung Hwang, Ki Joong Kim, Jong-Hee Chae, In-One Kim, Sung-Hye Park, and Seung-Ki Kim

I ntractable epilepsy in children is a serious condition that handicaps the afflicted individual in every aspect of life. 1 The physical, psychological, and social life of the patients deteriorate rapidly with continuing seizures. Epilepsy surgery can be a remedy for intractable epilepsy in carefully selected patients. 31 One characteristic of pediatric epilepsy is that developmental lesions predominate as the cause of the disease. Focal cortical dysplasia is the most common developmental lesion responsible for intractable epilepsy in children. 26

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Virendra R. Desai, Aditya Vedantam, Sandi K. Lam, Lucia Mirea, Stephen T. Foldes, Daniel J. Curry, P. David Adelson, Angus A. Wilfong, and Varina L. Boerwinkle

T he incidence of pediatric epilepsy ranges from 23–102 per 100,000 individuals in the US, with up to one-third of these cases remaining medically refractory. 14 , 22 In these cases, various surgical techniques may be utilized to achieve seizure freedom, including resection, functional disconnection, stereotactic laser ablation, vagal nerve stimulation, and reciprocal neurostimulation. 10 , 18 , 29 Especially given the increased frequency of atypical language organization in this patient population, determining language laterality and localization in pediatric

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Jason S. Hauptman, Andrew Dadour, Taemin Oh, Christine B. Baca, Barbara G. Vickrey, Stefanie D. Vassar, Raman Sankar, Noriko Salamon, Harry V. Vinters, and Gary W. Mathern

mostly adult epilepsy surgery. 3 , 5 , 12 , 14 However, these studies have not routinely addressed whether practice patterns and referral have evolved over time. This study was designed to determine if there were changes in sociodemographic variables over the 25-year history of the UCLA pediatric epilepsy surgery program. Pediatric epilepsy surgery patients were categorized by referral location within California and the US. Our goal was to ascertain how these variables changed over time and if they were linked with timing of referral, surgical outcomes, and other

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Erin N. Kiehna, Catherine F. McClung-Smith, and Robert J. Bollo

EC , Weil AG , Duchowny M , Bhatia S , Ragheb J , Miller I : MR-guided laser interstitial thermal therapy for pediatric drug-resistant lesional epilepsy . Epilepsia 56 : 1590 – 1598 , 2015 10.1111/epi.13106 26249524 7 Liava A , Mai R , Tassi L , Cossu M , Sartori I , Nobili L , : Paediatric epilepsy surgery in the posterior cortex: a study of 62 cases . Epileptic Disord 16 : 141 – 164 , 2014 24853765 8 Ramos-Lizana J , Rodriguez-Lucenilla MI , Aguilera-López P , Aguirre-Rodríguez J , Cassinello-García E : A

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Min-Hee Lee, Nolan B. O’Hara, Hirotaka Motoi, Aimee F. Luat, Csaba Juhász, Sandeep Sood, Eishi Asano, and Jeong-Won Jeong

, Bollo RJ : Preoperative evaluation and surgical decision-making in pediatric epilepsy surgery . Transl Pediatr 5 : 169 – 179 , 2016 27709099 10.21037/tp.2016.06.02 10 Fernández-Miranda JC , Wang Y , Pathak S , Stefaneau L , Verstynen T , Yeh FC : Asymmetry, connectivity, and segmentation of the arcuate fascicle in the human brain . Brain Struct Funct 220 : 1665 – 1680 , 2015 24633827 10.1007/s00429-014-0751-7 11 Garyfallidis E , Brett M , Correia MM , Williams GB , Nimmo-Smith I : QuickBundles, a method for tractography