Pediatric Epilepsy Surgery: Global Survey of Surgical Approaches
Georgia Ramantani, Dario Englot, Dorottya Cserpan, Javier Aparicio, Alexis Arzimanoglou, William Bingaman, Kees Braun, Richard J. Burman, Lixin Cai, Dezhi Cao, Roberto Caraballo, Judith Helen Cross, Cristine Mella Cukiert, Daniel Curry, Luca De Palma, Georg Dorfmüller, Johannes M. Nico Enslin, Aria Fallah, Sarah Ferrand Sorbets, Martha Feucht, Deepak Gill, Tove Hallbook, Anthony Simon Harvey, Hans Holthausen, Masaki Iwasaki, Yuwu Jiang, Thilo Kalbhenn, Lakshminarayanan Kannan, Kensuke Kawai, Takayuki Kikuchi, Niklaus Krayenbühl, Noritsugu Kunihiro, Matt Lallas, Carolina Munoz Castro, Sandeep Bhagwan Patil, Tom Pieper, Jonathan Roth, Mary Lou Smith, Muhammad Zubair Tahir, Martin Tisdall, Manjari Tripathi, Takehiro Uda, Naotaka Usui, Ahsan Moosa Naduvil Valappil, Elaine Wirrell, Oscar Zorro Guio, Arthur Cukiert, Howard L. Weiner,BACKGROUND AND OBJECTIVES:
Pediatric epilepsy surgery is an established treatment, but current global data on surgical practices are limited. This study, conducted by the International League Against Epilepsy Pediatric Epilepsy Surgery Taskforce, provides an updated international overview of surgical approaches and their regional variation.
METHODS:
Group-level data were collected from 61 epilepsy surgery programs (49 pediatric-only) across 29 countries on 6 continents. All children and adolescents who underwent epilepsy surgery in 2023 were included. The study was designed to enable direct comparison with the similar survey conducted by the International League Against Epilepsy in 2004.
RESULTS:
The cohort comprised 2427 patients. Resections accounted for 50.6% and disconnections for 23.0% of procedures. Resection rates were highest in Oceania (87.3%) and lowest in North America (40.3%). Resections were 43.0% unilobar—most commonly temporal (39.6%) and frontal (32.7%)—and 9.7% multilobar, with 61.9% involving the posterior quadrant. Hemispheric surgeries comprised 12.9% of all cases (highest in South America: 18.1%). Subcortical procedures (eg, for hypothalamic hamartomas or deep-seated lesions) represented 2.7% (highest in South America: 12.1%). Intraoperative electrocorticography was used in 38.3% of cases, most commonly in Oceania (84.1%) and Asia (85.5%). Minimally invasive techniques were used in 7.7% of cases, with the highest rate in North America (16.9%). Laser interstitial thermal therapy was most common (4.9%), followed by radiofrequency ablation (2.1%), endoscopic surgery (0.7%), and radiosurgery (0.1%). Corpus callosotomy was performed in 5.9% of all cases, and no multiple subpial transections were reported. Neurostimulation was used in 14.7% of patients, highest in North America (35.6%), and included vagal nerve stimulation (11.8%), deep brain stimulation (1.5%), and responsive neurostimulation (1.4%).
CONCLUSION:
Resections and disconnections, including extensive multilobar and hemispheric procedures, remain the core procedures of pediatric epilepsy surgery. Although minimally invasive and neuromodulatory techniques are increasingly used in selected regions—particularly North America—their global adoption remains limited.