Skip to main content

Advertisement

SpringerLink
Log in

Lesionectomy in the pediatric age

  • Special Annual Issue
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

Due to the development of electrophysiological recordings and the advancement in neuroimaging, which has allowed the identification of underlying focal abnormalities, in some patients with partial seizures, the surgical removal of such lesions has gained widespread recognition as a treatment modality for medically intractable epilepsy.

Discussion

In patients having a well-defined lesion, a good correlation between clinical and electrophysiological features, suggesting a zone of seizures onset around (or even in) the lesion, is the best guarantee to achieve good seizure control by “lesionectomy”. However, other factors correlate with the seizure outcome.

Conclusion

The persistency of seizures was found to be significantly associated with the completeness of the resection of the lesion and the preoperative duration of epilepsy, and, in some cases, the de novo brain damage induced by the surgical procedure itself. However, given the benefits of seizure control on the developing brain and the risk of secondary epileptogenesis, early surgery is recommended in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Aicardi J, Chevrie J (1982) A typical benign partial epilepsy of childhood. Dev Med Child Neurol 24(3):281–292

    PubMed  CAS  Google Scholar 

  2. al-Rodhan NR, Kelly PJ, Cascino GD, Sharbrough FW (1992) Surgical outcome in computer-assisted stereotactic resection of intra-axial cerebral lesions for partial epilepsy. Stereotact Funct Neurosurg 58(1–4):172–177

    Article  PubMed  CAS  Google Scholar 

  3. Awad I, Nayel M (1992) Epilepsy surgery: introduction and overview. Clin Neurosurg 38:493–513

    PubMed  CAS  Google Scholar 

  4. Barkovich A, Rowley H, Andermann F (1995) MR in partial epilepsy: value of high-resolution volumetric techniques. AJNR Am J Neuroradiol 16(2):339–343

    PubMed  CAS  Google Scholar 

  5. Blumcke I, Wiestler OD (2002) Gangliogliomas: an intriguing tumor entity associated with focal epilepsies. J Neuropathol Exp Neurol 61:575–584

    PubMed  Google Scholar 

  6. Blume W, Girvin J, Kaufmann J (1982) Childhood brain tumors presenting as chronic uncontrolled focal seizure disorders. Ann Neurol 12(6):538–541

    Article  PubMed  CAS  Google Scholar 

  7. Bourgeois M, Sainte-Rose C, Lellouch-Tubiana A, Malucci C, Brunelle F, Maixner W, Cinalli G, Pierre-Kahn A, Renier D, Zerah M, Hirsch JF, Goutieres F, Aicardi J (1999) Surgery of epilepsy associated with focal lesions in childhood. J Neurosurg 90(5):833–842

    PubMed  CAS  Google Scholar 

  8. Cascino GD, Jack CR Jr, Parisi JE, Marsh WR, Kelly PJ, Sharbrough FW, Hirschorn KA, Trenerry MR (1992) Identification of the epileptic focus: magnetic resonance imaging. Epilepsy Res Suppl 5:95–100

    PubMed  CAS  Google Scholar 

  9. Cascino GD, Jack CR Jr, Parisi JE, Marsh WR, Kelly PJ, Sharbrough FW, Hirschorn KA, Trenerry MR (1992) MRI in the presurgical evaluation of patients with frontal lobe epilepsy and children with temporal lobe epilepsy: pathologic correlation and prognostic importance. Epilepsy Res 11(1):51–59

    Article  PubMed  CAS  Google Scholar 

  10. Cataltepe O, Turanli G, Yalnizoglu D, Topcu M, Akalan N (2005) Surgical management of temporal lobe tumor-related epilepsy in children. J Neurosurg 102(Suppl 3):280–287

    PubMed  Google Scholar 

  11. Clusmann H, Kral T, Gleissner U, Sassen R, Urbach H, Blumcke I, Bogucki J, Schramm J (2004) Analysis of different types of resection for pediatric patients with temporal lobe epilepsy. Neurosurgery 54(4):847–859

    Article  PubMed  Google Scholar 

  12. Devinsky O, Perrine K, Vazquez B, Luciano DJ, Dogali M (1994) Multiple subpial transactions in the language cortex. Brain 117:255–265

    Article  PubMed  Google Scholar 

  13. Dogali M, Devinsky O, Luciano D, Perrine K (1994) Invasive intracranial monitoring, cortical resection and multiple subpial transection for the control of intractable complex partial seizure of cortical onset. Stereotact Funct Neurosurg 62(1–4):222–225

    Article  PubMed  CAS  Google Scholar 

  14. Drake JM, Prudencio J, Holowaka S, Rutka JT, Hoffman HJ, Huphreys RP (1994) Frameless stereotaxy in children. Pediatr Neurosurg 20(2):152–159

    Article  PubMed  CAS  Google Scholar 

  15. Duchowny M (1995) Epilepsy surgery in children. Curr Opin Neurol 8(2):112–116

    Article  PubMed  CAS  Google Scholar 

  16. Giulioni M, Acciarri N, Padovani R, Galassi E (1995) Results of surgery in children with cerebral cavernous angiomas causing epilepsy. Br J Neurosurg 9(2):135–141

    Article  PubMed  CAS  Google Scholar 

  17. Goldring S (1987) Pediatric epilepsy surgery. Epilepsia 28(Suppl 1):82–102

    Article  Google Scholar 

  18. Goldring S, Rich K, Picker S (1986) Experience with gliomas in patients presenting with a chronic seizure disorder. Clin Neurosurg 33:15–42

    PubMed  CAS  Google Scholar 

  19. Green R, Adler J, Erba G (1988) Epilepsy surgery in children. J Child Neurol 3(3):155–166

    Article  PubMed  CAS  Google Scholar 

  20. Hirsch J (1989) Epilepsy and brain tumours in children. J Neuroradiol 16(4):292–300

    PubMed  CAS  Google Scholar 

  21. Hirsch J, Sainte Rose C, Pierre-Kahn A, Pfister A, Hoppe-Hirsch E (1989) Benign astrocytic and oligodendrocytic tumors of the cerebral hemispheres in children. J Neurosurg 70(4):568–572

    PubMed  CAS  Google Scholar 

  22. Holmes G (1993) Surgery for intractable seizures in infancy and early childhood. Neurology 43(11 Suppl 5):S28–S37

    PubMed  CAS  Google Scholar 

  23. Hughlings-Jackson J (1882–1883) Localised convulsions from tumour of the brain. Brain 5:364–374

    Article  Google Scholar 

  24. Iannelli A, Guzzetta F, Battaglia D, Iuvone L, Di Rocco C (2000) Surgical treatment of temporal tumors associated with epilepsy in children. Pediatr Neurosurg 3:248–254

    Article  Google Scholar 

  25. Khajavi K, Comair YG, Wyllie E, Palmer J, Morris HH, Hahn FJ (1999) Surgical management of pediatric tumor-associated epilepsy. J Child Neurol 14:15–25

    Article  PubMed  CAS  Google Scholar 

  26. Kim JH (2001) Pathology of epilepsy. Exp Mol Pathol 70:345–367

    Article  PubMed  CAS  Google Scholar 

  27. Kim S, Wang K, Cho B (1995) Intractable seizures associated with brain tumor in childhood: lesionectomy and seizure outcome. Childs Nerv Syst 11(11):634–638

    Article  PubMed  CAS  Google Scholar 

  28. Kirkpatrick PJ, Honavar M, Janota I, Polkey CE (1993) Control of temporal lobe epilepsy following en bloc resection of low-grade tumors. J Neurosurg 78:19–25

    Article  PubMed  CAS  Google Scholar 

  29. Kuzniecky R (1995) MRI in cerebral developmental malformations and epilepsy. Magn Reson Imaging 13(8):1137–1145

    Article  PubMed  CAS  Google Scholar 

  30. Liu Z, Zhao Q, Li S, Tian Z, Cui Y, Feng H (1995) Multiple subpial transection for treatment of intractable epilepsy. Chin Med J (Engl) 108(7):539–541

    CAS  Google Scholar 

  31. Meyer F, Marsh W, Laws E, Sharbrough FW (1986) Temporal lobectomy in children with epilepsy. J Neurosurg 64:371–376

    PubMed  CAS  Google Scholar 

  32. Mizrahi E, Kellaway P, Grossman R, Rutecki PA, Armstrong D, Rettig G, Loewen S (1990) Anterior temporal lobectomy and medically refractory temporal lobe epilepsy of childhood. Epilepsia 31:302–312

    Article  PubMed  CAS  Google Scholar 

  33. Montes JL, Rosenblatt B, Farmer JP, O’Gorman AM, Andermann F, Watters GV, Meagher-Villemure K (1995) Lesionectomy of MRI detected lesions in children with epilepsy. Pediatr Neurosurg 22(4):167–173

    Article  PubMed  CAS  Google Scholar 

  34. Morrell F (1985) Secondary epileptogenesis in man. Arch Neurol 42(4):318–335

    PubMed  CAS  Google Scholar 

  35. Morrell F (1989) Varieties of human secondary epileptogenesis. J Clin Neurophysiol 6(3):227–275

    Article  PubMed  CAS  Google Scholar 

  36. Morrell F, Whisler W, Bleck T (1989) Multiple subpial transection: a new approach to the surgical treatment of focal epilepsy. J Neurosurg 70(2):231–239

    Article  PubMed  CAS  Google Scholar 

  37. Olivier A (1988) Risk and benefit in the surgery of epilepsy: complications and positive results on seizures tendency and intellectual function. Acta Neurol Scand 78(Suppl 117):114–121

    Article  Google Scholar 

  38. Otsubo H, Ochi A, Elliott I, Chung SH, Rutka JT, Jay V, Aung M, Sobel DF, Snead OC (2001) MEG predicts epileptic zone in lesional extrahippocampal epilepsy: 12 pediatric surgery cases. Epilepsia 42(12):1523–1530

    Article  PubMed  CAS  Google Scholar 

  39. Palmini A, Andermann F, Olivier A Tampieri D, Robitaille Y (1991) Focal neuronal migration disorders and intractable partial epilepsy: results of surgical treatment. Ann Neurol 30:750–757

    Article  PubMed  CAS  Google Scholar 

  40. Penfield W (1954) Temporal lobe epilepsy. Br J Surg 41(168):337–343

    Article  PubMed  CAS  Google Scholar 

  41. Rasmussen T (1975) Surgery of epilepsy associated with brain tumors. Adv Neurol 8:227–239

    PubMed  CAS  Google Scholar 

  42. Rougier A (1990) The epileptic focus versus the pathological focus. Acta Neurochir Suppl (Wien) 50:1–5

    CAS  Google Scholar 

  43. Spencer S (1995) MRI and epilepsy surgery. Neurology 45(7):1248–1250

    PubMed  CAS  Google Scholar 

  44. Storrs B (1992) Surgery for epilepsy in children. J S C Med Assoc 88(5):256–257

    PubMed  CAS  Google Scholar 

  45. Taylor D, Lochery M (1991) Behavioral consequences of epilepsy in children. Developing a psychosocial vocabulary. Adv Neurol 55:153–162

    PubMed  CAS  Google Scholar 

  46. Williamson A, Patrylo PR, Lee S, Spencer DD (2003) Physiology of human cortical neurons adjacent to cavernous malformations and tumors. Epilepsia 44(11):1413–1419

    Article  PubMed  Google Scholar 

  47. Wyllie E (1991) Cortical resection for children with epilepsy. Perspectives in pediatrics. Am J Dis Child 145(3):314–320

    PubMed  CAS  Google Scholar 

  48. Wyllie E, Comair Y, Kotagal P, Wyllie E, Comair Y, Kotagal P (1996) Epilepsy surgery in infants. Epilepsia 37(7):625–637

    Article  PubMed  CAS  Google Scholar 

  49. Wyllie E, Luders H, Morris HH 3rd, Lesser RP, Dinner DS, Hahn J, Estes ML, Rothner AD, Erenberg G, Cruse R et al (1987) Clinical outcome after complete or partial cortical resection for intractable epilepsy. Neurology 37(10):1634–1641

    PubMed  CAS  Google Scholar 

  50. Wyllie E, Rothner A, Luders H (1989) Partial seizures in children: clinical features, medical treatment, and surgical considerations. Pediatr Clin North Am 36(2):343–364

    PubMed  CAS  Google Scholar 

  51. Zaatreh MM, Firlik KS, Spencer DD, Spencer SS (2003) Temporal lobe tumoral epilepsy: characteristics and predictors of surgical outcome. Neurology 61(5):636–641

    PubMed  Google Scholar 

Download references

Acknowledgement

We thank Dr Virginia Maixner MD for her editing assistance.

Author information

Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015, Paris, France

    Marie Bourgeois, Federico Di Rocco & Christian Sainte-Rose

Authors
  1. Marie Bourgeois
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Federico Di Rocco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Sainte-Rose
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie Bourgeois.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bourgeois, M., Di Rocco, F. & Sainte-Rose, C. Lesionectomy in the pediatric age. Childs Nerv Syst 22, 931–935 (2006). https://doi.org/10.1007/s00381-006-0146-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-006-0146-z

Keywords

Search

Navigation