Pediatric Epilepsy Surgery

Pediatric Epilepsy Surgery
	Epilepsy surgery in children: Time is critical
	Section I. PRESURGICAL EVALUATION IN CHILDREN
		CHAPTER 1. The role and limits of seizure semiology
			What can be determined from semiologyin children?
			Age dependence of semiology
		CHAPTER 2. The role and limits of surface EEG and source imaging
			Surface EEG
				General principles
				Developmental substrates – Maturational issues
				The epileptic generator
				Technical issues
				Practical “dos and don’ts” – Tips to avoid pitfalls
			Source imaging
				Background
				Basic principles of source imaging
				Localization of the epileptogenic zone in conjunction with other non-invasive neurophysiological and imaging modalities
				Contribution to the decision making relevant to the indication for invasive monitoring
				ESI/MSI: pros and cons
				EEG-triggered fMRI
		CHAPTER 3. The role and limits of structural and functional neuroimaging
			Structural imaging in presurgical evaluation
			Functional imaging to identify the epileptogenic zone
			Mapping eloquent cortex
		CHAPTER 4. The role and limitations of cognitive evaluation
			Purposes of the presurgical neuropsychological evaluation
			Domains included in the neuropsychological evaluation and guidelines for determining assessment tools within those domains
				School-age children
				Considerations for young (preschool) and children with intellectual disability
			Intracarotid anaesthetic procedures in children
				Language testing
				Memory
			Challenges for and limitations of the presurgical neuropsychological evaluation in children
			Future directions
		CHAPTER 5. The role and limits of behavioral and psychiatric evaluation
			Overlap of epilepsy and psychiatric conditions
			Neurologic pathways to psychiatric illness
			Common psychiatric comorbidities
				Attention deficit hyperactivity disorder (ADHD)
				Anxiety and depression
				Comorbidity in drug-resistant epilepsy
			Surgery in neurology and psychiatry
			Role of neurobehavioral evaluation
			Elements of neurobehavioral evaluation
			Risk and benefit analysis
			Limits of neurobehavioral evaluation
			Research directions for the future
		CHAPTER 6. Intracranial EEG recordings and electrical stimulation
			General indications
			iEEG methods: subdural/depth, SEEG, ECoG
				Subdural electrodes and combination of subdural/depth electrodes
				Stereo-electro-encephalography (SEEG)
				Intra-operative electro-corticography (ECoG)
			Defining the epileptogenic zone (EZ): spontaneous and provoked
				Ictal onset zone
				Irritative, continuous epileptiform discharges, and functional deficit zones
			Defining critical cortex: intra-operative and extra-operative
				Extra-operative electrical stimulation
				Intra-operative electrical stimulation
		CHAPTER 7. Why is the epilepsy case conference important?
		CHAPTER 8. Socio-economic aspects and epilepsy surgery in children
			What is required?
			Developing (“resource poor”) countries
				Africa
				South Asia
				China
				Middle East
				Latin America
			Developed (“resource equipped”) countries
			Specific paediatric issues
				Types of surgeries?
				Solutions
	Section II. SEMIOLOGY IN CHILDREN
		CHAPTER 9. The temporal lobe: Semiology
			Ictal signs of temporal lobe seizures
				Behavioral change
				Ictal emotional signs
				Ictal motor signs
				Autonomic symptoms
			Age dependency of different peri-ictal signs
			Etiology and seizure semiology
			Lateralizing signs in childhood temporal lobe seizures
			Interobserver agreement on childhood seizure semiology
			Further pitfalls of TLE seizure semiology
				“Temporal-like” seizure semiology in extratemporal epilepsies
				TLE caused by extratemporal lesions
		CHAPTER 10. The frontal lobe: Semiology
			Frontal lobe functional anatomyrelevant to seizure semiology
			Clinical patterns of frontal lobe ictal semiology
				Tonic seizures
				Versive seizures
				Hypermotor seizures
				Motor stereotypies
				Autonomic seizures
			Differential diagnosis and frontal lobe epilepsy syndromes
			Do pediatric frontal lobe seizures and epilepsy differ from adults?
		CHAPTER 11. The posterior cortex: Semiology
			Semiology of seizures originating from the parietal lobe
			Semiology of seizures originating from the occipital lobe
			Particular findings in young children
				Auras
				Oculo-motor manifestations
				Simple and complex motor behaviours
				EEG features
		CHAPTER 12. The insula: Semiology
			Overview
			Insular lobe semiology in children: is there any specificity?
				Auras
				Vegetative signs
				Motor manifestations
	Section III. ETIOLOGY AND EPILEPSY SURGERY
		CHAPTER 13. Focal (isolated) cortical dysplasia Type I
			Histological classification of FCD Type I – work in progress
			Imaging in isolated FCD Type I
				MRI in isolated FCD Type I
				PET and SPECT in isolated FCD Type I
			Seizures in FCD Type I
			EEG in FCD Type I
			Presurgical work-up and epilepsy surgery in FCD Type I
		CHAPTER 14. Focal cortical dysplasia Type II
			Histopathological and MR aspects of FCD type II
				Histopathological aspects
				Neuroradiological methodology and diagnosis
			Clinical and neurophysiological aspects
				Clinical data
				EEG and video-EEG features
			Invasive techniques and surgical outcome
				Invasive monitoring: when and why
				Surgery and outcome
		CHAPTER 15. Other malformations of cortical development
			Heterotopias
				Subependymal (periventricular) nodular heterotopias
				Subcortical nodular heterotopias
				Subcortical band heterotopias
			Polymicrogyria
		CHAPTER 16. Tuberous sclerosis
			Clinical presentation
			Surgical referral and pre-operative assessment
			Intracranial EEG recordings
			Surgical approaches
			Outcome
		CHAPTER 17. Hemimegalencepahly and diffuse hemispheric malformations of cortical development
			Specific epilepsy surgery indications
			Recommended presurgical evaluation
				Clinical considerations
				Interictal and ictal video EEG
			Available results
				Seizures
				Contra-lateral hemiplegia and homonymous lateral hemianopia
			Suggested follow-up
		CHAPTER 18. Benign tumors (WHO grades I and II)
			Neuro-pathological classification of brain tumors WHO grade I and II frequently associated with epilepsy (so-called LEATs)
			MRI in patients with epilepsy in association with brain tumors
			Incidences, prevalences, frequencies in pediatric brain tumors
			Brain tumors and epileptogenicity
			Medical therapy/AEDs in children with epilepsy in association with brain tumors
			Surgery in children with seizures associated with benign tumors
				Tumor-surgery vs. epilepsy surgery and lesionectomy vs. tailored resection
			Radiotherapy and chemotherapy in patients with epilepsy and benign supratentorial brain tumors (WHO grade I and II)
			Surgery in patients with epilepsy in association with brain tumors WHO grade II and higher
		CHAPTER 19. Vascular causes and perinatal hypoxic-ischemic events
			Prenatal and perinatal lesions
				Arterial ischemic strokes and porencephalic cysts in children
				Venous stroke and cerebral sinovenous thrombosis
				Intracranial hemorrhage and hemorrhagic stroke in term infants
				Watershed lesions and ulegyria due to hypoxic ischemic events
				Vascular lesions in preterm children
				Seizure types and epilepsy syndromes in pre/perinatal vascular lesions
				Presurgical evaluation in pre/perinatal vascular lesions
				Surgery in pre- and perinatal vascular lesions and lesions caused by hypoxic ischemic events
				Postoperative outcome
			Epilepsy surgery in vascular lesions occurring in childhood
			Cavernomas
				Epidemiology
				Seizures and epilepsy
				Pathophysiology and neuroimaging
				Surgical treatment and outcome
			Hematological testing for neurosurgery
		CHAPTER 20. Sturge-Weber syndrome
			Clinical presentation
			Diagnostic workup
			Medical and surgical treatment
		CHAPTER 21. Hypothalamic hamartoma
			History
			Epidemiology
			Genetics
			Anatomical aspects
			Pathology and pathophysiology
			Clinical-EEG features and natural history
				Gelastic and dacrystic seizures
				Other seizure types
				Cognition and behaviour
				Psychiatric symptoms
			HH and epilepsy: which part of the brain is seizing?
				Intrinsic epileptogenesis
				Secondary epileptogenesis
				The running-down phenomenon
			Presurgical evaluation
				Magnetic resonance (MR) imaging
				Electroencephalography and video-EEG seizure monitoring
				Neuropsychological or neurodevelopmental testing
				Electrocorticography and invasive EEG monitoring
			Treatment
				Surgical treatment
				Antiepileptic drugs
				Vagus nerve stimulation
				Ketogenic diet
				Corpus callosotomy
				Deep brain stimulation
		CHAPTER 22. Cerebello-pontine hamartoma
			Clinical presentation
			Pathological and functional considerations
			Surgical treatment and outcomes
			Concluding remarks
		CHAPTER 23. Epilepsies following cerebral infections
			Epilepsy post-viral encephalitis
			Epilepsy post-herpes simplex virus encephalitis
				Epilepsy surgery in post-encephalitis epilepsy (PEE)
			Epilepsies post-bacterial meningitis (EPBM)
				Epilepsy surgery in epilepsies post-bacterial meningitis
			Epilepsy in neurocysticercosis (NCC)
				Epilepsy surgery for epilepsy due to NCC
			Epilepsy surgery in rare post-infection epilepsy
		CHAPTER 24. Rasmussen encephalitis
			Historical perspective
			Diagnosis
				General comments
				European Consensus criteria
				Differential diagnosis
				Ancillary studies
			Pathology
			Treatment
				Medical treatment
				Surgery
			Outcomes
				Seizure control
				Sensori-motor function
				Vision
				Cognitive/developmental outcomes
				Language function
				Adaptive function
				Educational outcomes
				Mood/behavior/psychological
				Quality of life
				Outcomes in adulthood
				Summary of outcomes
			Timing of surgery
			Post-surgical management
			Directions for future research
		CHAPTER 25. Post-traumatic epilepsy
			Epidemiology
				Prevalence and incidence
				Risk factors
			Pathophysiology
			Treatment
				Medical
				Surgical
		CHAPTER 26. Mesial temporal lobe epilepsy in children
			Pathological substrates of pediatric temporal lobe epilepsy
			Risk factors for pediatric temporal lobe epilepsy
			Role of dual pathology in pediatric temporal lobe epilepsy
			Clinical manifestations of temporal lobe epilepsy in children
			EEG features of pediatric temporal lobe epilepsy
			Surgical outcome in children with hipocampal sclerosis and dual pathology
				Timing of surgeries in relation to neuropsychological outcome
				Surgical technique
				Outcome regarding seizures
		CHAPTER 27. Epilepsy surgery in MRI-negative patients
			MRI-negative focal epilepsy
				Difference between MRI-negative and non-lesional epilepsy
				Factors influencing MRI diagnosis
				Influence of the MRI technique and timing of evaluation
				Unspecific and subtle MRI abnormalities
				Definition of MRI-negativity
			Selection of surgical candidates
			Presurgical diagnostic work-up
				3D-MEG/EEG source analysis
				PET and SPECT
				Multimodal non-invasive diagnostic work-up
				Invasive EEG
				Functional considerations
			Outcome after MRI-negative epilepsy surgery
		CHAPTER 28. Landau-Kleffner syndrome
			Background, clinical presentation and differential diagnosis
			Multiple subpial transections of the dorsal surface of the temporal gyrus into the sylvian fissure
			Recommended presurgical evaluation
				Methohexitol suppression test (MHXT)
				Electrical intracarotid amobarbital test
				Magnetoencephalography (MEG)
			Available results
			Specific follow-up
			New ideas about aetiology
	Section IV. SURGICAL TECHNIQUES FOR THE NEUROLOGIST
		CHAPTER 29. Lesionectomy
			Patient selection
			General principles
				Anesthesia protocol
				Image guidance
				Skin/bone/dura
				Delineation of the lesion
				Hemostasis/closure
			Safety
				Deep seated lesion
				Eloquent areas
			Complete resection boundaries
				Lesion-specific considerations
				Anatomic or electrophysiological limits?
				Mesial temporal lobe lesions
			Respect of the non-epileptic brain
			Future of lesionectomy?
		CHAPTER 30. Surgery for temporal lobe epilepsy
			Historical background of surgical treatment
			Planning resection
			General surgical remarks
			Considerations in tumors associated with drug-resistant epilepsy
			Resection strategies
			Surgical steps for standard anterior temporal lobectomy
			Surgical steps for combined temporal pole and mesial resection
			Surgical steps for transsylvian selective amygdalo-hippocampectomy
			Surgical steps for transcortical selective amygdalo-hippocampectomy
			Surgical steps for subtemporal selective amygdalo-hippocampectomy
			Surgical steps for extended lesionectomy
			Results
				Histopathological findings
				Seizure outcome
				Developmental and cognitive outcome
				Operative complications
		CHAPTER 31. Extratemporal localization and eloquent areas
			Presurgical evaluation
				Neurophysiology
				MEG
				Neuroimaging
			Surgery
				Surgical decision-making
				Anesthetic considerations
				Neuronavigation and intra-operative MRI
				Surgical technique: resection/disconnection
				Cortical resections
				Disconnections
				Multiple subpial transections
				Intra-operative monitoring
				Thermal ablation
			Outcomes
				Functional and developmental outcome
				Complications
				Pathology
		CHAPTER 32. Corpus callosotomy: Surgical techniques
			Surgical history
			Specific technical aspects, open surgery
			Pitfalls
			Results and outcome
			Complication considerations
			Considerations and caveats before performing the callosotomy
		CHAPTER 33. Hemispherotomy and multilobar surgery
			Historical background: from hemispherectomy to hemispherotomy
			Description of the surgical procedures of hemispherotomy
			Advantages and disadvantages of horizontal and vertical hemispherotomies
			Multilobar disconnection and resection
				Posterior disconnection
				Other multilobar surgeries
			Surgical planning
			Perioperative management
			Outcome
				Seizure outcome
				Developmental outcome
				Repeated surgery
				Complications
		CHAPTER 34. Surgical procedures for hypothalamic hamartomas
			The “classical” neurosurgical approaches
			Recent alternative surgical techniques
				The transcallosal anterior interforniceal approach
				The endoscopic approach
				Stereotactic thermoablation
				Gamma Knife Radiosurgery
				Interstitial radiosurgery
				Other surgical approaches
		CHAPTER 35. Minimally invasive epilepsy surgery
			Principles and technological foundations of minimally invasive epilepsy surgery
			Modifications of standard epilepsy procedures using smaller and “keyhole” craniotomies
				Minimally invasive approaches to temporal lobe epilepsy surgery
				Minimally invasive approaches to hemispherectomy and other functional hemispherectomy variants of anatomical hemispherectomy
				Endoscopic epilepsy surgery
				Endovascular epilepsy surgery
				The future of minimally invasive epilepsy surgery
		CHAPTER 36. Pediatric epilepsy surgery techniques: a worldwide survey
			General issues
			Medical intraoperative management
			Skin preparation, opening and hemostasis
			Closure
			Postoperative imaging
			Anesthetic agents
			Temporal lobe resections
			Callosal section
			Hemispheric surgery
			Temporal lobe tumors
			Cavernoma
			Complications
			Neurosurgical pediatric epilepsy surgery training
		CHAPTER 37. Technical aspects of invasive monitoring
			Localizing the epileptogenic zone
			Localization of the functional/eloquent zone
			The subdural method
				Indications, advantages and disadvantages of subdurals
				Implantation technique of subdural grids alone or in combination with depth electrodes
			The stereo-electroencephalography (SEEG) method
				Indications, advantages and disadvantages of SEEG
				Technique of SEEG implantation
			Invasive monitoring morbidity
	Section V. PALLIATIVE EPILEPSY SURGERY
		CHAPTER 38. Corpus callosotomy: Indications and results
			Corpus callosotomy and seizure generalization
			Pre-operative evaluation and indications
			Lennox-Gastaut syndrome and callosotomy
			Other senarios for callosotomy
			Cognitive, behavioral, psychosocial, and quality of life outcomes
			Consequences of callosotomy
		CHAPTER 39. Vagus nerve stimulation
			VNS efficacy
			Quality of life
			Safety
		CHAPTER 40. Deep brain stimulation
			History of deep brain stimulation in epilepsy
			Overview of the different stimulation targets
				Epileptogenic network targets
				Ictal onset zone DBS
			Closed-loop DBS
			Deep brain stimulation in children
	Section VI. FOLLOWING SURGERY
		CHAPTER 41. Long-term follow-up and transition to adult life
			Acute post-surgical care
				Common issues
				Action plan
			Intermediate care
				Common issues
				Action plan
			Long term follow-up and transition to adult life
				Common issues
				Action items
		CHAPTER 42. Surgical failure, early recurrence and re-operation
			Surgical failure
			Reasons for failure: incomplete resection of the epileptogenic zone
				Incomplete pre-operative data
				Co-localization of eloquent and epileptogenic cortex
				Non-contiguous epileptogenic zones
				Insufficient intracranial electrode coverage
				Surgical inaccessability
			Emergence of a new epileptogenic focus
			Re-operation
		CHAPTER 43. Postoperative imaging
			Structural imaging modalities in the immediate and late postoperative period
			Expected and unexpected brain imaging findings in the immediate postoperative period
			Imaging and localization of implanted depth and subdural electrodes for invasive monitoring
			Brain imaging as a research tool in the postoperative epilepsy patient
			MRI safety of implanted neuromodulatory devices for epilepsy
		CHAPTER 44. Time to stop antiepileptic drugs
			Why should we consider reducing AEDs?
			What are the risks of reducing AEDs?
			Do we know if postoperative AED reduction increases relapse risk?
			What are the consequences of a seizure relapse following AED reduction?
			In whom should we consider AED withdrawal?
			When can we start to reduce AEDs?
				Current practice and opinions
				Is early postoperative withdrawal unsafe?
		CHAPTER 45. Cognition, language, and memory outcomes
			Temporal lobe resection
			Frontal lobe resection
			Parietal or occipital lobe resection
			Multilobar resection (excluding hemidisconnections)
			Hemispheric resection
			Age at surgery
			Long-term follow-up
		CHAPTER 46. Psychosocial outcomes following seizure surgery
			Adult reports of psychosocial outcome
				Behavior and emotion
			Social competence
			Quality of life, family, and satisfaction with outcome
		CHAPTER 47. Comprehensive evaluation of outcomes
			What is needed to report outcome?
			Seizure outcome
			Complications/unexpected events
			Neurocognitive and psychiatric outcome
			Psychosocial/quality of life
	Section VII. FUTURE PERSPECTIVES
		CHAPTER 48. A comprehensive epilepsy surgery program for children: State-of-the-art and future perspectives
			Specificities of childhood epilepsies
			The surgical treatment gap
			Candidates for a presurgical evaluation or a patient eligible for surgery: On what do they differ
			Professional expertise
			Which presurgical evaluation strategy and for whom
				Minimal requirements
				Video-EEG recording of seizures
				Other investigation tools
				Invasive VEEG monitoring
			Postoperative long-term follow-up facilities
			Future challenges and perspectives