Our experience of pediatric epilepsy surgery





pediatric epilepsy, anterior temporal lobectomy, lesionectomy, callosotomy, hemispherotomy


Objective: to evaluate the effectiveness and safety of different operations in children with drug-resistant epilepsy.

Materials and Method. 91 children with drug-resistant epilepsy were enrolled in a retrospective study. Mean age was 10.3±5.1 years. Anterior temporal lobectomy was performed in 16 (57.1%) patients, lesionectomy – in 9 (10.0%), microsurgical callosotomy in 18 (19.8%), stereotactic callosotomy in 7 (7.7%), multifocal resections in 4 (4.4%), functional hemispherotomy in 14 (15.6%). Stereotactic radiofrequency callosotomy was performed on a CRW Stereotactic frame (Radionics Inc., USA). Ultrasound navigation and neuronavigation were used in 6 (7%) and 14 (15%) cases correspondingly. Intraoperative corticography was applied in 8 (9%) cases. Postoperative long-term follow-up lasted from 1 to 17 years (mean - 8.2±2.1 years).

Results. An epileptogenic zone within single hemisphere was indentified in 66 (72.2%) cases, while bilateral epileptiform activity was observed in 25 (27.5%) children. The most common etiologies of epilepsy included hypoxic-ischemic encephalopathy, intracerebral hemorrhage, meningoencephalitis, Rasmussen syndrome, cortical dysplasia, tumors.
After surgery 51 (56%) patients became seizures free (Engel 1), 14 (15.4%) patients had rare auras or focal seizures (Engel 2). In 25 (27.5%) cases, seizure frequency reduction was less than 75% or did not change significantly. The most favorable outcomes were associated with resection procedures, resulting in complete seizure control in 46 (69.7%) out of 66 children, with significant improvement observed in 9 (13.6%) cases. After callosotomy drop-attacks stopped in 14 (78%) out of 18 who had them before surgery. Operative complications were encountered in 6 (6.6%) cases, postoperative mortality occurred in 1 (1.1%) case.

Conclusions. The key to the effectiveness of surgical treatment of childhood epilepsy is early surgical intervention, which leads to the control of epileptic seizures, correction of psychological and cognitive emotional disorders and improvement of quality of life. The combination of resection procedures and disconnections contributes to the reduction of epileptogenic neurons and suppression of epileptic discharges.


1. Panayaiotopoulos CP. A Clinical guide to epileptic syndromes and their treatment. Springer London; 2010. [CrossRef]

2. Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord. 2015 Jun;17(2):117-23. [CrossRef] [PubMed]

3. Zack MM, Kobau R. National and State Estimates of the Numbers of Adults and Children with Active Epilepsy - United States, 2015. MMWR Morb Mortal Wkly Rep. 2017 Aug 11;66(31):821-825. [CrossRef] [PubMed] [PubMed Central]

4. Fine A, Wirrell EC. Seizures in Children. Pediatr Rev. 2020 Jul;41(7):321-347. [CrossRef] [PubMed]

5. Guerrini R. Epilepsy in children. Lancet. 2006 Feb 11;367(9509):499-524. [CrossRef] [PubMed]

6. Jayalakshmi S, Vooturi S, Gupta S, Panigrahi M. Epilepsy surgery in children. Neurol India. 2017 May-Jun;65(3):485-492. [CrossRef] [PubMed]

7. Madaan P, Gupta A, Gulati S. Pediatric Epilepsy Surgery: Indications and Evaluation. Indian J Pediatr. 2021 Oct;88(10):1000-1006. [CrossRef] [PubMed]

8. Dorfmüller G, Delalande O. Pediatric epilepsy surgery. Handb Clin Neurol. 2013;111:785-95. [CrossRef] [PubMed]

9. Jayakar A, Bolton J. Pediatric epilepsy surgery. Curr Neurol Neurosci Rep. 2015 Jun;15(6):31. [CrossRef] [PubMed]

10. Armour EA, Yiu AJ, Shrey DW, Reddy SB. Underrepresented Populations in Pediatric Epilepsy Surgery. Semin Pediatr Neurol. 2021 Oct;39:100916. [CrossRef] [PubMed]

11. Galan FN, Beier AD, Sheth RD. Advances in Epilepsy Surgery. Pediatr Neurol. 2021 Sep;122:89-97. [CrossRef] [PubMed]

12. Engel J Jr. The current place of epilepsy surgery. Curr Opin Neurol. 2018 Apr;31(2):192-197. [CrossRef] [PubMed] [PubMed Central]

13. Raybaud C, Shroff M, Rutka JT, Chuang SH. Imaging surgical epilepsy in children. Childs Nerv Syst. 2006 Aug;22(8):786-809. [CrossRef] [PubMed]

14. Ahmed R, Rutka JT. The role of MEG in pre-surgical evaluation of epilepsy: current use and future directions. Expert Rev Neurother. 2016 Jul;16(7):795-801. [CrossRef] [PubMed]

15. Engel J, Van Ness PC, Rasmussen TB, Ojemann LM. Outcome with respect to epileptic seizures Surgical Treatment of the Epilepsies. In: Engel J, editor. Surgical Treatment of Epilepsies. New York: Raven Press, 1993. P.609–621. ISBN-13: 978-0881679885. ISBN-10: 0881679887

16. Çataltepe O, Jallo GI. Pediatric Epilepsy Surgery: Preoperative Assessment and Surgical Treatment. Thieme. New York, Stuttgart. 2010. ISBN-13: 978-1626238169.

17. Cross JH, Jayakar P, Nordli D, Delalande O, Duchowny M, Wieser HG, Guerrini R, Mathern GW; International League against Epilepsy, Subcommission for Paediatric Epilepsy Surgery; Commissions of Neurosurgery and Paediatrics. Proposed criteria for referral and evaluation of children for epilepsy surgery: recommendations of the Subcommission for Pediatric Epilepsy Surgery. Epilepsia. 2006 Jun;47(6):952-9. [CrossRef] [PubMed]

18. Fattorusso A, Matricardi S, Mencaroni E, Dell’Isola GB, Di Cara G, Striano P, Verrotti A. The Pharmacoresistant Epilepsy: An Overview on Existant and New Emerging Therapies. Front Neurol. 2021 Jun 22;12:674483. [CrossRef] [PubMed] [PubMed Central]

19. Matern TS, DeCarlo R, Ciliberto MA, Singh RK. Palliative Epilepsy Surgery Procedures in Children. Semin Pediatr Neurol. 2021 Oct;39:100912. [CrossRef] [PubMed]

20. Kostiuk KR, Cheburakhin VV, Buniakin VM. [Hemispherotomy in the surgical treatment of severe symptomatic epilepsy]. Ukrainian Neurosurgical Journal. 2019;25(3):35-42. Ukrainian. [CrossRef]

21. Kostiuk KR, Buniakin VM, Cheburakhin VV, Shevelov MM, Medvedev YM, Popov AO, Tevzadze DA, Dichko SM, Musulievska VV, Kanaikin OM. [Surgical treatment for multifocal epilepsy]. Zaporozhye Medical Journal. 2022 Jan 26;24(1):70-8. Ukrainian. [CrossRef]

22. Beatty CW, Lockrow JP, Gedela S, Gehred A, Ostendorf AP. The Missed Value of Underutilizing Pediatric Epilepsy Surgery: A Systematic Review. Semin Pediatr Neurol. 2021 Oct;39:100917. [CrossRef] [PubMed]

23. Capraz IY, Kurt G, Akdemir Ö, Hirfanoglu T, Oner Y, Sengezer T, Kapucu LO, Serdaroglu A, Bilir E. Surgical outcome in patients with MRI-negative, PET-positive temporal lobe epilepsy. Seizure. 2015 Jul;29:63-8. [CrossRef] [PubMed]

24. Delgado-Garcia G, Frauscher B. Future of Neurology & Technology: Stereo-electroencephalography in Presurgical Epilepsy Evaluation. Neurology. 2021 Nov 19:10.1212/WNL.0000000000013088. [CrossRef] [PubMed]

25. George DD, Ojemann SG, Drees C, Thompson JA. Stimulation Mapping Using Stereoelectroencephalography: Current and Future Directions. Front Neurol. 2020 May 12;11:320. [CrossRef] [PubMed] [PubMed Central]

26. Dorfer C, Rydenhag B, Baltuch G, Buch V, Blount J, Bollo R, Gerrard J, Nilsson D, Roessler K, Rutka J, Sharan A, Spencer D, Cukiert A. How technology is driving the landscape of epilepsy surgery. Epilepsia. 2020 May;61(5):841-855. [CrossRef] [PubMed] [PubMed Central]

27. Arya R, Rutka JT. Pediatric epilepsy surgery: Toward increased utilization and reduced invasiveness. Neurology. 2018 Feb 27;90(9):401-402. [CrossRef] [PubMed]

28. Solli E, Colwell NA, Markosian C, Johal AS, Houston R, Iqbal MO, Say I, Petrsoric JI, Tomycz LD. Underutilization of advanced presurgical studies and high rates of vagus nerve stimulation for drug-resistant epilepsy: a single-center experience and recommendations. Acta Neurochir (Wien). 2022 Feb;164(2):565-573. [CrossRef] [PubMed]

29. Hoppe C, Helmstaedter C. Laser interstitial thermotherapy (LiTT) in pediatric epilepsy surgery. Seizure. 2020 Apr;77:69-75. [CrossRef] [PubMed]



How to Cite

Kostiuk, K. R., & Buniakin, V. M. (2023). Our experience of pediatric epilepsy surgery. Ukrainian Neurosurgical Journal, 29(3), 34–42. https://doi.org/10.25305/unj.282642



Original articles