LESIONECTOMY OF MRI DETECTED LESIONS IN CHILDREN WITH EPILEPSY

The results of complete excision of cerebral lesions detected by MRI i n 18 children presenting with epilepsy were analyzed. There were 14 bo ys and 4 girls with a mean age of 9.2 years. The average age of onset of seizures was 6.8 years. The mean time from onset of seizures to sur gery was 2.3 years. Often, CT scans suggested that the lesions were in dolent. MRI was better in differentiating neoplastic from developmenta l lesions. Angiography was non-contributory in this series. Interictal EEGs showed epileptiform activity correlating with imaging studies in 54% of children. The lesion was completely surgically excised in all patients. This was confirmed by intra-operative ultrasound and postope rative imaging. Electrocorticography was performed prior to and after the resection, but residual spiking did not lead to further resection. The average postoperative follow-up was 5.7 years. Five patients had low grade astrocytomas, 4 had gangliogliomas, 1 a mixed astrocytoma-ol igodendroglioma, 3 had cortical dysplasia, 2 infantile desmoplastic ga ngliogliomas, 2 hamartomata, and 1 cavernous angioma. Sixteen patients have been seizure-free since surgery. Only 2 have partial seizures. T hus, all patients benefited from the resection, with respect to seizur e control. In those with temporal lobe lesions, improvement in IQ was seen postoperatively. Early consideration of surgery in patients with epilepsy and lesions demonstrated by MRT is suggested.