Reasons for not reoperating and outcomes of reoperation after seizure recurrence in pediatric epilepsy surgery: A population-based study.

OBJECTIVE

Epilepsy surgery is an established and effective treatment for children with drug-resistant epilepsy. Although the majority of patients become seizure-free postoperatively, 20%-40% experience seizure recurrence. Although repeat surgery can achieve seizure freedom in selected cases, the reasons children with seizure recurrence do not undergo reoperation remain poorly understood. We aimed to characterize the reasons for not pursuing reoperation and to evaluate the outcomes of repeat epilepsy surgery in a nationwide pediatric cohort.

METHODS

We conducted a retrospective study of all patients <19 years old who underwent resective epilepsy surgery at the national pediatric epilepsy surgery center in Finland between 2002 and 2023. Patients with postoperative seizure recurrence were included. Clinical characteristics, reasons for not undergoing reoperation, and surgical outcomes were analyzed.

RESULTS

Of 245 children who underwent resective epilepsy surgery, 104 experienced postoperative seizure recurrence. After exclusion of four patients who died during follow-up, nine who had undergone hemispherotomy, and 12 undergoing palliative primary surgery, 79 patients were included in the study cohort. Of these, 35 (44.3%) underwent reoperation, accounting for 45 reoperations in total. The most common reason for not pursuing reoperation was low seizure burden (59.1%). Patient or family refusal was rare. After the final surgery, 14 of 35 patients (40.0%) achieved Engel class I outcome. Unexpected complications occurred in two of 35 patients after the first reoperation (5.7%) and in six of 45 of all reoperation procedures (13.3%).

SIGNIFICANCE: Reoperation is a meaningful treatment option in children with seizure recurrence after "Ошибка" initial epilepsy surgery. Clinical factors, particularly seizure burden, predominantly determine reoperation candidacy. These findings support systematic reevaluation at specialized epilepsy surgery centers following seizure recurrence after initial surgery in pediatric patients.