{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:38:02Z","timestamp":1792586282501,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Epilepsy surgery is an established and effective treatment for children with drug\u2010resistant epilepsy. Although the majority of patients become seizure\u2010free postoperatively, 20%\u201340% 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study of all patients &lt;19\u2009years 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 245 children who underwent resective epilepsy surgery, 104 experienced postoperative seizure recurrence. After exclusion of four patients who died during follow\u2010up, 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%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Reoperation is a meaningful treatment option in children with seizure recurrence after \u201cfailed\u201d 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70561","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:38:13Z","timestamp":1792582693000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reasons for not reoperating and outcomes of reoperation after seizure recurrence in pediatric epilepsy surgery: A population\u2010based study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8379-1584","authenticated-orcid":false,"given":"Vincent","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Helsinki University Hospital  Helsinki Finland"},{"name":"Epilepsia\u2010Helsinki Helsinki University Hospital, full member of European Reference Network EpiCARE  Helsinki Finland"},{"name":"Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0788-3662","authenticated-orcid":false,"given":"Atte","family":"Karppinen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Helsinki University Hospital  Helsinki Finland"},{"name":"Epilepsia\u2010Helsinki Helsinki University Hospital, full member of European Reference Network EpiCARE  Helsinki Finland"},{"name":"Faculty of Medicine University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4189-8438","authenticated-orcid":false,"given":"Eija","family":"Gaily","sequence":"additional","affiliation":[{"name":"Epilepsia\u2010Helsinki Helsinki University Hospital, full member of European Reference Network EpiCARE  Helsinki 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University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2067-256X","authenticated-orcid":false,"given":"Eeva\u2010Liisa","family":"Mets\u00e4honkala","sequence":"additional","affiliation":[{"name":"Epilepsia\u2010Helsinki Helsinki University Hospital, full member of European Reference Network EpiCARE  Helsinki Finland"},{"name":"Department of Pediatric Neurology Helsinki University Hospital  Helsinki 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