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Makridis KL, Atalay DA, Thomale UW, Tietze A, Elger CE, Kaindl AM. Epilepsy surgery in the first six months of life: A systematic review and meta-analysis. Seizure 2022; 96:109-117. [DOI: 10.1016/j.seizure.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 11/16/2022] Open
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Melikyan AG, Kushel YV, Sorokin VS, Vlasov PA, Demin MO, Shults EI, Shevchenko AM, Strunina YV. [Lessons learnt from 101 hemispheric pediatric epilepsy surgeries part ii: pitfalls and complications]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:44-52. [PMID: 34951759 DOI: 10.17116/neiro20218506144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the spectrum of pitfalls and complications after hemisherotomy basing on a retrospective study of a large consecutive pediatric cohort of patients from a single institution. MATERIAL AND METHODS One hundred and one patients (med. age - 43 months) with refractory seizures underwent hemispherotomy. Developmental pathology was the anatomical substrate of disorder in 42 patients. The infantile post-stroke scarring and gliosis was the origin of epilepsy in the majority of 43 cases with acquired etiology. The progressive pathology (RE, S-W and TS) was the etiology in the rest of children (16 cases). The lateral periinsular technique was used to isolate the sick hemisphere in 55 patients; the vertical parasagittal approach was employed in 46 cases. Median perioperative blood loss constituted 10.5 ml/kg, but was markedly larger in kids with hemimegaly (52.8 ml/kg); 57 patients needed hemotransfusion during surgery. Median length of stay in ICU was 14.7 hours, and the length of stay in the hospital until discharge - 6.5 days. Eight patients underwent second-look surgery to complete sectioning of undercut commissural fibers. FU is known in 91 patients (med. length - 1.5 years). RESULTS Major surgical complications with serious hemorrhage and/or surgery induced life-threatening events developed in 7 patients (one of them has died on the 5th day post-surgery for the causes of brain edema and uncontrolled hyponatremia). Various early and late infectious complications were noted in 4 cases. Ten patients experienced new not anticipated but temporary neurological deficit. Nine patients needed shunting for the causes of hydrocephalus within several first months post-hemispherotomy. Early seizure onset was associated with probability of all complications in general (p=0.02), and developmental etiology - with intraoperative bleeding and hemorrhagic complications (p=0.03). CONCLUSION Children with developmental etiology, particularly those with hemimegalencephaly, are most challengeable in terms of perioperative hemorrhage and serious complications. Patients with relapse or persisting seizures should be evaluated for the possibility of incomplete hemispheric isolation and have good chances to become SF by re-doing hemispherotomy.
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Affiliation(s)
| | - Yu V Kushel
- Burdenko Neurosurgical Center, Moscow, Russia
| | - V S Sorokin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - P A Vlasov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M O Demin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - E I Shults
- Burdenko Neurosurgical Center, Moscow, Russia
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Pindrik J, Hoang N, Smith L, Halverson M, Wojnaroski M, McNally K, Gedela S, Ostendorf AP. Preoperative evaluation and surgical management of infants and toddlers with drug-resistant epilepsy. Neurosurg Focus 2019; 45:E3. [PMID: 30173613 DOI: 10.3171/2018.7.focus18220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Despite perioperative risks, epilepsy surgery represents a legitimate curative or palliative treatment approach for children with drug-resistant epilepsy (DRE). Several factors characterizing infants and toddlers with DRE create unique challenges regarding optimal evaluation and management. Epilepsy surgery within children < 3 years of age has received moderate attention in the literature, including mainly case series and retrospective studies. This article presents a systematic literature review and explores multidisciplinary considerations for the preoperative evaluation and surgical management of infants and toddlers with DRE. METHODS The study team conducted a systematic literature review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, targeting studies that investigated children < 3 years of age undergoing surgical treatment of DRE. Using the PubMed database, investigators selected peer-reviewed articles that reported seizure outcomes with or without developmental outcomes and/or perioperative complications. Studies were eliminated based on the following exclusion criteria: sample size < 5 patients; and inclusion of patients > 3 years of age, when demographic and outcomes data could not be separated from the cohort of patients < 3 years of age. RESULTS The study team identified 20 studies published between January 1990 and May 2017 that satisfied eligibility criteria. All selected studies represented retrospective reviews, observational studies, and uncontrolled case series. The compiled group of studies incorporated 465 patients who underwent resective or disconnective surgery (18 studies, 444 patients) or vagus nerve stimulator insertion (2 studies, 21 patients). Patient age at surgery ranged between 28 days and 36 months, with a mean of 16.8 months (1.4 years). DISCUSSION The study team provided a detailed summary of the literature review, focusing on the etiologies, preoperative evaluation, surgical treatments, seizure and developmental outcomes, and potential for functional recovery of infants and toddlers with DRE. Additionally, the authors discussed special considerations in this vulnerable age group from the perspective of multiple disciplines. CONCLUSIONS While presenting notable challenges, pediatric epilepsy surgery within infants and toddlers (children < 3 years of age) offers significant opportunities for improved seizure frequency, neuro-cognitive development, and quality of life. Successful evaluation and treatment of young children with DRE requires special consideration of multiple aspects related to neurological and physiological immaturity and surgical morbidity.
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Affiliation(s)
- Jonathan Pindrik
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery.,2Department of Neurological Surgery, The Ohio State University College of Medicine; and
| | - Nguyen Hoang
- 2Department of Neurological Surgery, The Ohio State University College of Medicine; and
| | - Luke Smith
- 2Department of Neurological Surgery, The Ohio State University College of Medicine; and
| | - Mark Halverson
- 3Division of Pediatric Neuroradiology, Department of Radiology, and
| | - Mary Wojnaroski
- 4Section of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's Hospital
| | - Kelly McNally
- 4Section of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's Hospital
| | - Satyanarayana Gedela
- 5Division of Child Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Adam P Ostendorf
- 5Division of Child Neurology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
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Vedantam A, Pan IW, Staggers KA, Lam SK. Thirty-day outcomes in pediatric epilepsy surgery. Childs Nerv Syst 2018; 34:487-494. [PMID: 29086075 DOI: 10.1007/s00381-017-3639-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/17/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to use the multicenter American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) to evaluate and identify risk factors for 30-day adverse events in children undergoing epilepsy surgery. METHODS Using the 2015 NSQIP-P database, we identified children (age 0-18 years) undergoing pediatric epilepsy surgery and analyzed NSQIP-defined complications, unplanned reoperations, and unplanned readmissions. Multivariable logistic regression analysis was performed using perioperative data to identify risk factors for adverse events within 30 days of the index procedure. RESULTS Two hundred eight pediatric patients undergoing epilepsy surgery were identified for the year 2015 in the NSQIP-P database. The majority of patients were male (51.8%) and white (72.9%). The median age was 10 years. Neurological and neuromuscular comorbidities were seen in 62.5% of patients. Surgical blood loss and transfusion was the most common overall NSQIP-defined event (15.7%) and was reported in 40% with hemispherectomy. Nineteen patients (6.8%) had an unplanned reoperation and 20 patients (7.1%) had an unplanned readmission. Multivariable logistic regression analysis showed that African American patients (OR 3.26, 95% CI 1.29-8.21, p = 0.01) and hemispherectomy (OR 3.05, 95% CI 1.4-6.65, p = 0.01) were independently associated with NSQIP-defined complications. Patients undergoing hemispherectomy (OR 4.11, 95% CI 1.48-11.42, p = 0.01) were also at significantly higher risk of unplanned readmission after pediatric epilepsy surgery. CONCLUSIONS Data from the 2015 NSQIP-P database showed that hemispherectomy was significantly associated with higher perioperative events in children undergoing epilepsy surgery. Quality improvement initiatives for hemispherectomy should target surgical blood loss and wound-related complications. Racial disparities in access to cranial pediatric epilepsy surgery and perioperative complications were also highlighted in the present study.
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Affiliation(s)
- Aditya Vedantam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - I-Wen Pan
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Kristen A Staggers
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
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Thudium MO, von Lehe M, Wessling C, Schoene-Bake JC, Soehle M. Safety, feasibility and complications during resective pediatric epilepsy surgery: a retrospective analysis. BMC Anesthesiol 2014; 14:71. [PMID: 25157215 PMCID: PMC4142256 DOI: 10.1186/1471-2253-14-71] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 08/13/2014] [Indexed: 02/08/2023] Open
Abstract
Background Resective epilepsy surgery is an established and effective method to reduce seizure burden in drug-resistant epilepsy. It was the objective of this study to assess intraoperative blood loss, transfusion requirements and the degree of hypothermia of pediatric epilepsy surgery in our center. Methods Patients were identified by our epilepsy surgery database, and data were collected via retrospective chart review over the past 25 years. Patients up to the age of 6 years were included, and patients with insufficient data were excluded. Results Forty-five patients with an age of 3.2 ± 1.6 (mean ± SD) years and a body weight of 17 [14; 21.5] kg (median [25%, 75% percentile]) were analysed. Duration of surgery was 3 h 49 min ± 53 min, which was accompanied by an intraoperative blood loss of 150 [90; 300] ml. This corresponded to 11.7 [5.2; 21.4] % of estimated total blood volume, ranging from 0 to 75%. A minimal haemoglobin count of 8.8 ± 1.4 g/dl was measured, which was substituted with erythrocyte concentrate (100 [0; 250] ml) in 23 patients. Body core temperature dropped from 36.0 ± 0.7°C at baseline to a minimum of 35.7 ± 0.7°C, and increased significantly (p < 0.001) thereafter to 37.1 ± 0.7°C until the end of surgery. A significant (p = 0.0003) correlation between duration of surgery and blood loss (Pearson r = 0.52) was observed. However, age, minimal body temperature or number of antiepileptic drugs seemed to have no impact on blood loss. Conclusion Resective epilepsy surgery is a safe procedure even in the pediatric population, however it is associated with significant blood loss especially during long surgical procedures.
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Affiliation(s)
- Marcus O Thudium
- Department of Anesthesiology and Intensive Care Medicine, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Marec von Lehe
- Department of Neurosurgery, University of Bochum, Knappschaftskrankenhaus, In der Schornau 23-25, 44892 Bochum, Germany
| | - Caroline Wessling
- Department of Neurosurgery, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Jan-Christoph Schoene-Bake
- Department of Pediatrics, University of Freiburg Medical Center, Heiliggeiststraße 1, 79106 Freiburg im Breisgau, Germany
| | - Martin Soehle
- Department of Anesthesiology and Intensive Care Medicine, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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Hauptman JS, Mathern GW. Epilepsy neurosurgery in children. HANDBOOK OF CLINICAL NEUROLOGY 2012; 108:881-95. [PMID: 22939072 DOI: 10.1016/b978-0-444-52899-5.00034-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Jason S Hauptman
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
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Lee JH, Lee Y, In J, Chung SH, Shin HI, Lee K, Kim KO, Cho H. Response of cerebral oximetry to increase in alveolar concentration of desflurane: effect of remifentanil and cerebrovascular CO 2reactivity. Korean J Anesthesiol 2009; 56:543-551. [DOI: 10.4097/kjae.2009.56.5.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jeoung Hyuk Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Younsuk Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Junyong In
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Seung-Hyun Chung
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Hong-il Shin
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Kyoungjin Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Kyoung Ok Kim
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
| | - Hun Cho
- Department of Anesthesiology and Pain Medicine, Dongguk University College of Medicine, Ilsan Hospital, Goyang, Korea
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Abstract
BACKGROUND Children with seizure disorders unresponsive to medical management may undergo surgical disconnection of a cerebral hemisphere, or hemispherectomy, in order to reduce or eliminate seizures. Because early cessation of seizures is thought to improve developmental outcomes, infants and young children with intractable seizures are undergoing hemispherectomies with increasing frequency. Previously, these procedures have been noted to be accompanied by severe cardiovascular, pulmonary, neurologic and coagulopathic complications. Newer surgical techniques (i.e. 'functional' rather than 'anatomic' hemispherectomy) and improved anesthetic management may reduce the perioperative complication rate of this procedure. The aim of this case series was to determine the incidence of major complication of functional hemispherectomy in our institution. METHODS A retrospective chart review was conducted of all children <3 years of age undergoing functional hemispherectomies for intractable seizures over a 4-year period at our institution. RESULTS Seven children were identified. No serious cardiovascular, pulmonary, neurologic or coagulopathic adverse events occurred. Perioperative blood loss and its sequelae were the most common complication. Postoperative management was generally uncomplicated, although one patient required readmission to the ICU for treatment of diabetes insipidus. All children survived and, at latest follow-up, all but one remained seizure-free. CONCLUSION This small case series suggests that improvements in anesthetic and surgical techniques may be associated with a decreased complication rate for infants and small children undergoing seizure surgery than previously reported.
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Affiliation(s)
- Sean Flack
- Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA.
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Abstract
BACKGROUND AND AIM Remifentanil is an ultra-short-acting opioid, increasingly used today in neuroanesthesia and neurointensive care. Its characteristics make remifentanil a potentially ideal agent, but previous data have cast a shadow on this opioid, supporting potentially toxic effects on the ischemic brain. The aim of the present concise review is to survey available up-to-date information on the effects of remifentanil on the central nervous system. METHOD A MEDLINE search within the past seven years for available up-to-date information on remifentanil and brain was performed. RESULTS Concise up-to-date information on the effects of remifentanil on the central nervous system was reported, with a particular emphasis on the following topics: cerebral metabolism, electroencephalogram, electrocorticography, motor-evoked potentials, regional cerebral blood flow, cerebral blood flow velocity, arterial hypotension and hypertension, intracranial pressure, cerebral perfusion pressure, cerebral autoregulation, cerebrovascular CO(2) reactivity, cerebrospinal fluid, painful stimulation, analgesia and hyperalgesia, neuroprotection, neurotoxicity and hypothermia. CONCLUSION The knowledge of the influence of remifentanil on brain functions is crucial before routine use in neuroanesthesia to improve anesthesia performance and patient safety as well as outcome.
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Affiliation(s)
- V Fodale
- Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, Italy.
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