Pediatric Epilepsy Surgery (cont.)

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What are the risks of epilepsy surgery?

Some of the risks associated with epilepsy surgery are related to the presurgical evaluation. Some of the tests performed require the use of contrast material that might result in severe allergic reactions. Implanting electrodes in the brain or placing electrodes on the surface of the brain for continuous monitoring requires surgical procedures that are not very complicated but may be associated with bleeding or infections.

Many tests, as well as the different surgical procedures, require the use of heavy sedation or general anesthesia. General anesthesia has a very small risk of death.

There are several risks inherent to the surgery, for example, bleeding inside the brain. Bleeding inside the brain might result in additional brain damage, besides; the accumulation of blood might increase the pressure inside the cranium resulting in severe complications, including death. Also the operation may be complicated by infections that can result in meningitis. A later complication of these events could be the development of hydrocephalus, which may require another surgical procedure.

As described before, resective surgery implies the removal of a piece of the brain that in some instances could be as much as the whole hemisphere. This resective surgery may aggravate prior functional deficits or may result in new ones. These complications may occur even after very careful evaluation.

The range of complications varies with the extent of the surgery and the area removed. For example:

  • operations near the motor areas might result in paralysis or weakness in the arms or legs, or loss of fine motor coordination in the hands;
  • operations near the language areas might result in language disorders;
  • operations near the cortical visual areas might result in visual deficits.

In the particular case of the callosotomy, since there is some degree of disconnection between the right and the left side of the brain, besides the complications already mentioned, some annoying subtle deficiencies may be experienced. For example, some patients may be able to identify, by visual recognition, objects presented to one side of the brain, but might not be able to name them because the memory of the name is in the other side of the brain. In general there are fewer complications with callosotomies than with resective surgery.

Yet, as in the case with all surgeries, there is always the risk of failure. In the case of epilepsy surgery this means recurrence of the epileptic seizures after the operation. Depending upon the type of pre-existing lesion, the failure rate may be as high as 50%. However, even in these cases, the seizures may be easily controlled with medications after the surgery.

In general there are very few complications observed after surgery. A small percentage of children who have had epilepsy surgery experience complications, and even fewer have neurological complications. Mortality (death) is very rare.

As previously mentioned, there is plasticity in the brain of young children, mostly up to the age of 7 to 9 years. The plasticity helps in the recovery of deficits that can be the result of surgery. For example, for children in whom the language areas were affected by the surgery there is remarkable recovery of language functions. Therefore, young children with intractable seizures who are candidates for surgery are much better off when the surgery is done sooner than later.

Previous contributing medical author: Harley I. Kornblum, MD, PhD

Medically reviewed by Jon Glass, MD; American board of Psychiatry and Neurology

REFERENCE:

"Overview of the treatment of seizures and epileptic syndromes in children"
uptodate.com


Medically Reviewed by a Doctor on 2/25/2014

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