Pediatric Epilepsy

Medically refractory pediatric epilepsy is a common problem in pediatric neurosurgery, resulting in serious morbidity and cognitive delay in pediatric patients. Traditionally, the preoperative management of refractory epilepsy has involved comprehensive imaging studies, observation, and both noninvasive and invasive methods of electrographic monitoring. With recent developments in stereotactic neurosurgery, invasive intracranial monitoring may be accomplished by stereotactic placement of depth electrodes, which can significantly decrease operative morbidity and improve operative workflow. These benefits are especially pronounced in cases where extensive multifocal or bilateral epilepsy monitoring is indicated. Furthermore, recent developments in laser interstitial thermal therapy for the treatment of pediatric epilepsy have allowed for significant reduction of seizure burden without performing extensive craniotomies. This is of special interest to patients with conditions such as tuberous sclerosis or hypothalamic hamartomas, which traditionally may have required multiple craniotomies for extensive epilepsy monitoring, iterative craniotomies for seizure control, or deep surgical approaches associated with increased morbidity. Instead, the advent of stereotactic neurosurgical methods allows for less invasive monitoring and treatment of epilepsy in patients with these conditions and other etiologies of epilepsy, and may form the basis of a new paradigm for neurosurgical management of pediatric epilepsy.