Surgical treatment for refractory XXXX : The Detroit series.

@entity1 @entity410 @entity66 @entity260 @entity739 @entity302
OBJECTIVE: We reviewed our experience of surgery for @entity302 ( @entity302 ) with or without history of @entity739 . METHODS: Data were reviewed from 65 (33 male) @entity1 with @entity302 who underwent surgery between 1993 and 2014; palliative cases were excluded. RESULTS: Mean age at surgery was 5.1 (range 0.2-19) years, with mean postsurgical follow-up of 45.3 (6-120) months. Mean number of anticonvulsants used preoperatively was 4.2 (2-8), which decreased to 1.2 (0-4) postoperatively (p < 0.0001). Total hemispherectomy was the most commonly performed surgery (n = 20), followed by subtotal hemispherectomy (n = 17), multilobar resection (n = 13), lobectomy (n = 7), tuberectomy (n = 6), and lobectomy + tuberectomy (n = 2), with International League Against @entity302 (ILAE) class I outcome in 20, 10, 7, 6, 3, and 0 @entity1 , respectively (total 46/65 (71%); 22 off medication). Shorter duration of @entity302 (p = 0.022) and presence of magnetic resonance imaging (MRI) lesion (p = 0.026) were independently associated with class I outcome. Of 34 @entity1 operated <3 years after @entity410 onset, 30 (88%) achieved class I outcome. Thirty-seven (79%) of 47 @entity1 with lesional MRI had class-I outcome, whereas 9 (50%) of 18 with normal MRI had class I outcome. Positron emission tomography (PET) scan was abnormal in almost all @entity1 [61 (97%) of 63 with lateralizing/localizing findings in 56 (92%) of 61 @entity1 , thus helping in surgical decision making and guiding subdural grid placements, particularly in @entity1 with nonlesional MRI. Fifteen @entity1 had @entity260 , mostly minor. SIGNIFICANCE: @entity302 surgery in @entity302 @entity1 , with or without history of @entity739 , is best accomplished at an early age and in those @entity1 with @entity66 on MRI with electroencephalography (EEG) concordance. Good outcomes can be achieved even when there is no MRI lesion but positive PET localization.
