{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T21:24:53Z","timestamp":1784237093419,"version":"3.55.0"},"reference-count":39,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T00:00:00Z","timestamp":1719619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>A surgical \u201ctreatment gap\u201d in pediatric epilepsy persists despite the demonstrated safety and effectiveness of surgery. For this reason, the national surgical landscape should be investigated such that an updated assessment may more appropriately guide health care efforts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In our retrospective cross\u2010sectional observational study, the National Inpatient Sample (NIS) database was queried for individuals 0 to &lt;18\u2009years of age who had an International Classification of Diseases (ICD) code for drug\u2010resistant epilepsy (DRE). This cohort was then split into a medical group and a surgical group. The former was defined by ICD codes for \u2010DRE without an accompanying surgical code, and the latter was defined by DRE <jats:italic>and<\/jats:italic> one of the following epilepsy surgeries: any open surgery; laser interstitial thermal therapy (LITT); vagus nerve stimulation; or responsive neurostimulation (RNS) from 1998 to 2020. Demographic variables of age, gender, race, insurance type, hospital charge, and hospital characteristics were analyzed between surgical options. Continuous variables were analyzed with weight\u2010adjusted quantile regression analysis, and categorical variables were analyzed by weight\u2010adjusted counts with percentages and compared with weight\u2010adjusted chi\u2010square test results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>These data indicate an increase in epilepsy surgeries over a 22\u2010year period, primarily due to a statistically significant increase in open surgery and a non\u2010significant increase in minimally invasive techniques, such as LITT and RNS. There are significant differences in age, race, gender, insurance type, median household income, Elixhauser index, hospital setting, and size between the medical and surgical groups, as well as the procedure performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>An increase in open surgery and minimally invasive surgeries (LITT and RNS) account for the overall rise in pediatric epilepsy surgery over the last 22\u2009years. A positive inflection point in open surgery is seen in 2005. Socioeconomic disparities exist between medical and surgical groups. Patient and hospital sociodemographics show significant differences between the procedure performed. Further efforts are required to close the surgical \u201ctreatment gap.\u201d<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.18030","type":"journal-article","created":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T12:00:03Z","timestamp":1719662403000},"page":"2423-2437","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["National 22\u2010year epilepsy surgery landscape shows increasing open and minimally invasive pediatric epilepsy surgery"],"prefix":"10.1111","volume":"65","author":[{"given":"Meena","family":"Vessell","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Surgery Texas Children's Hospital  Austin Texas USA"},{"name":"Department of Neurosurgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1112-8418","authenticated-orcid":false,"given":"Andrew","family":"Willett","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville School of Medicine  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Ugiliweneza","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville School of Medicine  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayur","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Mutchnick","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville School of Medicine  Louisville Kentucky USA"},{"name":"Pediatric Neurosurgery Norton Neuroscience Institute  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell","family":"Boakye","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Chern","sequence":"additional","affiliation":[{"name":"Pediatric Neurosurgery Children's Healthcare of Atlanta  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Weiner","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Surgery Texas Children's Hospital  Austin Texas USA"},{"name":"Department of Neurosurgery Baylor College of Medicine  Houston Texas USA"},{"name":"Division of Pediatric Neurosurgery, Department of Surgery Texas Children's Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Neimat","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville School of Medicine  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1615335"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16959"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528\u20101167.2005.00410.x"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20104642(23)00082\u20102"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12912"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000013130"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2018.01.013"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16489"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2018.06.042"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.3171\/2022.7.FOCUS22331"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2018.12.010"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2012.06.016"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.3171\/2020.1.FOCUS19935"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318250d7ea"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/ons\/opy099"},{"key":"e_1_2_12_17_1","unstructured":"Centers for Medicare and Medicaid Services. 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