Hiroshi Otsubo1. 1. Department of Neurophysiology, The Hospital for Sick Children, The University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. hiotsubo@rogers.com
Abstract
OBJECTIVE: To review the development of epilepsy surgery for pediatric patients with intractable epilepsy at The Hospital for Sick Children in Toronto, Canada. METHODS: We retrospectively collected and reviewed published papers regarding pediatric epilepsy surgery since 1930's. RESULTS: First, McKenzie started a hemispherectomy for children. Hendrick established anatomical hemispherectomy for pediatric patients with hemiparesis and intractable seizures since 1964. Hoffman performed anterior temporal lobectomy and neocortical temporal resection for lesional tempolal lobe epilepsy with or without mesial temporal sclerosis since 1974. Thereafter, multimodal neuroimaging studies of CT scan, MRI, and XenonCT, SPECT and PET have been used to identify and remove the epileptogenic lesion and zone. In 1996, magnetoencephalography (MEG) was introduced to localize interictal spike sources and somatosensory evoked fields for children with intractable seizures. Snead and Rutka started subdural grid electrodes that were constructed by scalp video EEG, MRI and MEG findings. The clustered MEG spike source coregistered with the intraoperative neuronavigation system delineated the epileptogenic zone requiring completely excision for neocortical lesional epilepsy from 2000. CONCLUSION: The pediatric epilepsy surgery at the Hospital for Sick Children has been progressing from anatomical hemispherectomy to complete clusterectomy of MEG spikes sources that localized the epileptogenic zone. Cortical excision, lobectomy, hemisphelotomy, corpus callosotomy and vagal nerve stimulation have been applied to appropriate seizure types identified by advanced neurodiagnostic modalities. We furthermore develop non-invasive methods for localizing and understanding the epileptic network in pediatric epilepsy patients with developing brain.
OBJECTIVE: To review the development of epilepsy surgery for pediatric patients with intractable epilepsy at The Hospital for Sick Children in Toronto, Canada. METHODS: We retrospectively collected and reviewed published papers regarding pediatric epilepsy surgery since 1930's. RESULTS: First, McKenzie started a hemispherectomy for children. Hendrick established anatomical hemispherectomy for pediatric patients with hemiparesis and intractable seizures since 1964. Hoffman performed anterior temporal lobectomy and neocortical temporal resection for lesional tempolal lobe epilepsy with or without mesial temporal sclerosis since 1974. Thereafter, multimodal neuroimaging studies of CT scan, MRI, and XenonCT, SPECT and PET have been used to identify and remove the epileptogenic lesion and zone. In 1996, magnetoencephalography (MEG) was introduced to localize interictal spike sources and somatosensory evoked fields for children with intractable seizures. Snead and Rutka started subdural grid electrodes that were constructed by scalp video EEG, MRI and MEG findings. The clustered MEG spike source coregistered with the intraoperative neuronavigation system delineated the epileptogenic zone requiring completely excision for neocortical lesional epilepsy from 2000. CONCLUSION: The pediatric epilepsy surgery at the Hospital for Sick Children has been progressing from anatomical hemispherectomy to complete clusterectomy of MEG spikes sources that localized the epileptogenic zone. Cortical excision, lobectomy, hemisphelotomy, corpus callosotomy and vagal nerve stimulation have been applied to appropriate seizure types identified by advanced neurodiagnostic modalities. We furthermore develop non-invasive methods for localizing and understanding the epileptic network in pediatric epilepsypatients with developing brain.