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Microscopic and macroscopic infarct complicating pediatric epilepsy surgery.

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Title: Microscopic and macroscopic infarct complicating pediatric epilepsy surgery.
Authors: Rubinger, Luc, Hazrati, Lili‐Naz, Ahmed, Raheel, Rutka, James, Snead, Carter, Widjaja, Elysa
Source: Epilepsia (Series 4). Mar2017, Vol. 58 Issue 3, p393-401. 9p.
Subjects: Epilepsy surgery, Temporal lobectomy, Developmental disabilities, Seizures (Medicine), Mild cognitive impairment, Magnetic resonance imaging, Computed tomography
Abstract: Objective There is some suggestion that microscopic infarct could be associated with invasive monitoring, but it is unclear if the microscopic infarct is also visible on imaging and associated with neurologic deficits. The aims of this study were to assess the rates of microscopic and macroscopic infarct and other major complications of pediatric epilepsy surgery, and to determine if these complications were higher following invasive monitoring. Methods We reviewed the epilepsy surgery data from a tertiary pediatric center, and collected data on microscopic infarct on histology and macroscopic infarct on postoperative computed tomography ( CT) or magnetic resonance imaging ( MRI) done one day after surgery and major complications. Results Three hundred fifty-two patients underwent surgical resection and there was one death. Forty-two percent had invasive monitoring. Thirty patients (9%) had microscopic infarct. Univariable analyses showed that microscopic infarct was higher among patients with invasive monitoring relative to no invasive monitoring (20% vs. 0.5%, respectively, p < 0.001). Eighteen patients (5%) had macroscopic infarct on CT or MRI. Univariable analysis showed no significant difference in macroscopic infarct between invasive monitoring and no invasive monitoring (8% vs. 3%, respectively, p = 0.085). One patient with microscopic infarct had transient right hemiparesis, and two with both macroscopic and microscopic infarct had unexpected persistent neurologic deficits. Thirty-two major complications (9.1%) were reported, with no difference in major complications between invasive monitoring and no invasive monitoring (10% vs. 7%, p = 0.446). In the multivariable analysis, invasive monitoring increased the odds of microscopic infarct (odds ratio [ OR] 15.87, p = 0.009), but not macroscopic infarct ( OR 2.6, p = 0.173) or major complications ( OR 1.4, p = 0.500), after adjusting for age at surgery, sex, age at seizure onset, operative type, and operative location. Significance Microscopic infarct was associated with invasive monitoring, and none of the patients had permanent neurologic deficits. Macroscopic infarct was not associated with invasive monitoring, and two patients with macroscopic infarct had persistent neurologic deficits. [ABSTRACT FROM AUTHOR]
Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Microscopic and macroscopic infarct complicating pediatric epilepsy surgery.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Rubinger%2C+Luc%22&quot;&gt;Rubinger, Luc&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hazrati%2C+Lili‐Naz%22&quot;&gt;Hazrati, Lili‐Naz&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ahmed%2C+Raheel%22&quot;&gt;Ahmed, Raheel&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Rutka%2C+James%22&quot;&gt;Rutka, James&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Snead%2C+Carter%22&quot;&gt;Snead, Carter&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Widjaja%2C+Elysa%22&quot;&gt;Widjaja, Elysa&lt;/searchLink&gt;
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Epilepsia+%28Series+4%29%22&quot;&gt;Epilepsia (Series 4)&lt;/searchLink&gt;. Mar2017, Vol. 58 Issue 3, p393-401. 9p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Epilepsy+surgery%22&quot;&gt;Epilepsy surgery&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Temporal+lobectomy%22&quot;&gt;Temporal lobectomy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Developmental+disabilities%22&quot;&gt;Developmental disabilities&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Seizures+%28Medicine%29%22&quot;&gt;Seizures (Medicine)&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Mild+cognitive+impairment%22&quot;&gt;Mild cognitive impairment&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Magnetic+resonance+imaging%22&quot;&gt;Magnetic resonance imaging&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Computed+tomography%22&quot;&gt;Computed tomography&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
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  Data: Objective There is some suggestion that microscopic infarct could be associated with invasive monitoring, but it is unclear if the microscopic infarct is also visible on imaging and associated with neurologic deficits. The aims of this study were to assess the rates of microscopic and macroscopic infarct and other major complications of pediatric epilepsy surgery, and to determine if these complications were higher following invasive monitoring. Methods We reviewed the epilepsy surgery data from a tertiary pediatric center, and collected data on microscopic infarct on histology and macroscopic infarct on postoperative computed tomography ( CT) or magnetic resonance imaging ( MRI) done one day after surgery and major complications. Results Three hundred fifty-two patients underwent surgical resection and there was one death. Forty-two percent had invasive monitoring. Thirty patients (9%) had microscopic infarct. Univariable analyses showed that microscopic infarct was higher among patients with invasive monitoring relative to no invasive monitoring (20% vs. 0.5%, respectively, p &lt; 0.001). Eighteen patients (5%) had macroscopic infarct on CT or MRI. Univariable analysis showed no significant difference in macroscopic infarct between invasive monitoring and no invasive monitoring (8% vs. 3%, respectively, p = 0.085). One patient with microscopic infarct had transient right hemiparesis, and two with both macroscopic and microscopic infarct had unexpected persistent neurologic deficits. Thirty-two major complications (9.1%) were reported, with no difference in major complications between invasive monitoring and no invasive monitoring (10% vs. 7%, p = 0.446). In the multivariable analysis, invasive monitoring increased the odds of microscopic infarct (odds ratio [ OR] 15.87, p = 0.009), but not macroscopic infarct ( OR 2.6, p = 0.173) or major complications ( OR 1.4, p = 0.500), after adjusting for age at surgery, sex, age at seizure onset, operative type, and operative location. Significance Microscopic infarct was associated with invasive monitoring, and none of the patients had permanent neurologic deficits. Macroscopic infarct was not associated with invasive monitoring, and two patients with macroscopic infarct had persistent neurologic deficits. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1111/epi.13667
    Languages:
      – Code: eng
        Text: English
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      Pagination:
        PageCount: 9
        StartPage: 393
    Subjects:
      – SubjectFull: Epilepsy surgery
        Type: general
      – SubjectFull: Temporal lobectomy
        Type: general
      – SubjectFull: Developmental disabilities
        Type: general
      – SubjectFull: Seizures (Medicine)
        Type: general
      – SubjectFull: Mild cognitive impairment
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      – SubjectFull: Magnetic resonance imaging
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      – SubjectFull: Computed tomography
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    Titles:
      – TitleFull: Microscopic and macroscopic infarct complicating pediatric epilepsy surgery.
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            NameFull: Rubinger, Luc
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            NameFull: Hazrati, Lili‐Naz
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            NameFull: Ahmed, Raheel
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            NameFull: Rutka, James
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            NameFull: Snead, Carter
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            NameFull: Widjaja, Elysa
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              M: 03
              Text: Mar2017
              Type: published
              Y: 2017
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