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J Korean Child Neurol Soc. 2008 Nov;16(2):146-155. Korean. Original Article.
Choi KO , Kim HD , Lee JS , Kim DS .
Department of Pediatrics, Pediatric Epilepsy Clinic, Severance Childrens Hospital, Brain Reserch Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

PURPOSE: We retrospectively reviewed the presurgical data and postoperative outcome in children underwent extratemporal respective surgeries. METHODS: The twenty six patients(males 15, females 11, mean age 11.5 years, mean age of operation 9.3 years, mean age after operation 2.3 years) who received extratemporal lobe surgery in our institution between October 2003 to May 2008 were reviewed. Preoperative evaluation(video-EEG monitoring and neuroimagings) to determine the anatomical location of the ictal onset zone were used to delineate possible localized malformed cerebral cortex. We also performed intraoperative electrocorticography(EcoG), intracranial EEG monitoring. RESULTS: Postoperative outcome as defined by Engel classification were as follows; class I in 19(73%), II in 1(3.8%), III in 1(3.8%), and IV in 5(19.2%) patients. Most common pathologies were cortical dysplasia and microdysgenesis. Twenty patients received frontal, 2 patients received parietal, and 4 patients received occipital lobectomy. After surgery, marked improvement in developmental outcome was noted. Postsurgical complications were noted in 9 cases, without lasting sequelae. CONCLUSION: We achieved a seizure-free rate of 73% in pharmacoresistant epileptic pediatric patients after extratemporal lobectomy. From this experience, we recommend early surgical intervention in pediatric patients with medically refractory seizure who possess focal epileptogenic foci of extratemporal lobe origin, as we can expect higher success rate and fewer postsurgical complications compared to those reported in adults. The Multimodal investigation and wide resections of the cortex based on the EcoG findings might be necessary to better localize the site of extratemporal epilepsy and to reduce postoperative complications.

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