SURGICAL OUTCOMES OF LESIONECTOMY IN PEDIATRIC FOCAL MOTOR EPILEPSY: A FIVE-YEAR RETROSPECTIVE SERIES

Surgical treatment is an option for drug-resistant focal epilepsy associated with structural brain lesions. Optimal extent of resection and the role of intraoperative electrophysiological monitoring remain debated. This study describes surgical and seizure outcomes in pediatric patients with focal motor epilepsy treated with lesion-directed resection.

A retrospective study involving 16 pediatric patients who underwent surgery for focal motor epilepsy at the Pediatric Neurosurgery at Hospital Civil Fray Antonio Alcalde, Guadalajara, between January 2019 and December 2023. Data on histopathological diagnosis, extent of resection, use of intraoperative electrocorticography, postoperative complications, and seizure outcomes were analyzed. Seizure outcome was assessed 6 months postoperatively using the Engel classification.

The median age at surgery was 8 years (range 3–14). Gross total resection was achieved in 11 patients, subtotal resection in 2, and partial resection in 3. Histopathological diagnoses included dysembryoplastic neuroepithelial tumor (4 patients), focal cortical dysplasia (2), diffuse supratentorial low-grade glioma (2), cavernoma (2), pleomorphic xanthoastrocytoma (2), and other less frequent lesions (4). At 6 months, Engel class IA outcome was observed in 10 patients (62.5%), class IB in 2, class IIA in 2, and class III in 2. Transient postoperative motor deficits occurred in three patients and transient language deficit in one. One patient with high-grade glioma died 17 months postoperatively. Intraoperative electrocorticography was used in two cases.

In these series, lesion-directed resection, particularly when gross total resection was achieved, was associated with favorable short-term seizure control and low permanent morbidity, even in settings with limited access to intraoperative electrophysiological monitoring.