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.