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Epilepsy surgery in children: what the radiologist needs to know

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Abstract

This review updates the radiologist on current epilepsy surgery practice in children, with a specific focus on the role of imaging in pre-surgical work-up, current and novel surgical techniques, expected post-surgical imaging appearances and important post-operative complications. A comprehensive review of the current and emerging international practices in paediatric epilepsy surgical planning and post-operative imaging is provided with details on case-based radiological findings. A detailed discussion of the pathophysiology and imaging features of different epileptogenic lesions will not be discussed as this is not the objective of this paper. Epilepsy surgery can be an effective method to control seizures in certain children with drug-resistant focal epilepsy. Early surgery in selected appropriate cases can lead to improved cognitive and developmental outcome. Advances in neurosurgical techniques, imaging and neuroanaesthesia have driven a parallel expansion in the array of epilepsy conditions which are potentially treatable with surgery. The range of surgical options is now wide, including minimally invasive ablative procedures for small lesions such as hypothalamic hamartomata, resections for focal lesions like hippocampal sclerosis and complex disconnective surgeries for multilobar conditions like Sturge Weber Syndrome and diffuse cortical malformations. An awareness of the surgical thinking when planning epilepsy surgery in children, and the practical knowledge of the operative steps involved will promote more accurate radiology reporting of the post-operative scan.

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Authors and Affiliations

  1. Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK

    Kirsten Pearce, Luke Dixon, Felice D’Arco & Kshitij Mankad

  2. Department of Neurology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK

    Suresh Pujar & Krishna Das

  3. Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK

    Zubair Tahir & Martin Tisdall

Authors
  1. Kirsten Pearce
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  2. Luke Dixon
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  3. Felice D’Arco
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  4. Suresh Pujar
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  5. Krishna Das
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  6. Zubair Tahir
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  7. Martin Tisdall
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  8. Kshitij Mankad
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kirsten Pearce and Luke Dixon. The manuscript was written by Kirsten Pearce and Luke Dixon, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Kshitij Mankad.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Informed consent was obtained from all individual participants.

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KP and LD are joint first authors.

Key points

1. Epilepsy is the commonest chronic neurological disorder in children and can be associated with significant psychomotor and cognitive impairment.

2. The aim of pre-surgical work-up is to localise the epileptogenic zone and for there to be concordance between the clinical, electrical and radiological findings.

3. There are a wide variety of different operations which are tailored to different types of epilepsy. These can be broadly categorised into ablative, resective, disconnnective and palliative.

4. Awareness of the aim and risk of different epilepsy operations is essential to confidently interpret the often complex post-operative imaging.

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Pearce, K., Dixon, L., D’Arco, F. et al. Epilepsy surgery in children: what the radiologist needs to know. Neuroradiology 62, 1061–1078 (2020). https://doi.org/10.1007/s00234-020-02448-2

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  • DOI: https://doi.org/10.1007/s00234-020-02448-2

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