{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:54:03Z","timestamp":1783040043780,"version":"3.54.6"},"reference-count":39,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The risk of developing epilepsy after perinatal stroke, hypoxic\/ischemic injury, and intracerebral hemorrhage is significant, and seizures may become medically refractory in approximately 25% of these patients. Surgical management can be difficult due to multilobar or bilateral cortical injury, nonfocal or poorly lateralizing video electroencephalography (EEG) findings, and limited functional reserve. In this study the authors describe the surgical approaches, seizure outcomes, and complications in patients with epilepsy due to vascular etiologies in the perinatal period and early infancy.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The records were analyzed of 19 consecutive children and adults with medically refractory epilepsy and evidence of perinatal arterial branch occlusions, hypoxic\/ischemic insult, or hemorrhagic strokes, who underwent surgery at the Comprehensive Epilepsy Center of Beth Israel Medical Center and St. Luke's-Roosevelt Hospital Center. Preoperative findings including MRI, video EEG, functional MRI, and neuropsychological testing were analyzed. The majority of patients underwent staged operations with invasive mapping, and all patients had either extra- or intraoperative functional mapping.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In 7 patients with large porencephalic cysts due to major arterial branch occlusions, periinsular functional hemispherotomy was performed in 4 children, and in 3 patients, multilobar resections\/disconnections were performed, with 1 patient undergoing additional resections 3 years after initial surgery due to recurrence of seizures. All of these patients have been seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 15\u201377 months). Another 8 patients had intervascular border-zone ischemic infarcts and encephalomalacia, and in this cohort 2 hemispherotomies, 5 multilobar resections\/disconnections, and 1 focal cortical resection were performed. Seven of these patients remain seizure free (Engel Class IA) after a mean 4.5-year follow-up (range 9\u201394 months), and 1 patient suffered a single seizure after 2.5 years of seizure freedom (Engel Class IB, 33-month follow-up). In the final 4 patients with vascular malformation-associated hemorrhagic or ischemic infarction in the perinatal period, a hemispherotomy was performed in 1 case, multilobar resections in 2 cases, and in 1 patient a partial temporal lobectomy was performed, followed 6 months later by a complete temporal and occipital lobectomy due to ongoing seizures. All of these patients have had seizure freedom (Engel Class IA) with a mean follow-up of 4.5 years (range 10\u201380 months). Complications included transient monoparesis or hemiparesis in 3 patients, transient mutism in 1 patient, infection in 1 patient, and a single case of permanent distal lower-extremity weakness. Transient mood disorders (depression and anxiety) were observed in 2 patients and required medical\/therapeutic intervention.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Epilepsy surgery is effective in controlling medically intractable seizures after perinatal vascular insults. Seizure foci tend to be widespread and rarely limited to the area of injury identified through neuroimaging, with invasive monitoring directing multilobar resections in many cases. Long-term functional outcomes have been good in these patients, with significant improvements in independence, quality of life, cognitive development, and motor skills, despite transient postoperative monoparesis or hemiparesis and occasional mood disorders.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.3.peds13440","type":"journal-article","created":{"date-parts":[[2014,5,9]],"date-time":"2014-05-09T13:58:09Z","timestamp":1399643889000},"page":"58-67","source":"Crossref","is-referenced-by-count":28,"title":["Surgical management of medically refractory epilepsy due to early childhood stroke"],"prefix":"10.3171","volume":"14","author":[{"given":"Saadi","family":"Ghatan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, St. Luke's\/Roosevelt Hospital Center and Beth Israel Medical Center, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"McGoldrick","sequence":"additional","affiliation":[{"name":"Department of Neurology, Albert Einstein College of Medicine\/Beth Israel Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Palmese","sequence":"additional","affiliation":[{"name":"Department of Neurology, Albert Einstein College of Medicine\/Beth Israel Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maite","family":"La Vega-Talbott","sequence":"additional","affiliation":[{"name":"Department of Neurology, Albert Einstein College of Medicine\/Beth Israel Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Albert Einstein College of Medicine\/Beth Israel Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malgosia A.","family":"Kokoszka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Luke's\/Roosevelt Hospital Center and Beth Israel Medical Center, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert R.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St. Luke's\/Roosevelt Hospital Center and Beth Israel Medical Center, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Neurology, Albert Einstein College of Medicine\/Beth Israel Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds13440","series-title":"Epilepsia","first-page":"133","article-title":"Hemispheric surgery in children with refractory epilepsy: seizure outcome, complications, and adaptive function","volume":"48","author":"Basheer","year":"2007"},{"issue":"Suppl 2","key":"b2-peds13440","series-title":"Neurosurgery","first-page":"489","article-title":"Multistage epilepsy surgery: safety, efficacy, and utility of a novel approach in pediatric extratemporal epilepsy","volume":"62","author":"Bauman","year":"2008"},{"key":"b3-peds13440","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00006123-199707000-00004","article-title":"Surgical and neurological complications in a series of 708 epilepsy surgery procedures","volume":"41","author":"Behrens","year":"1997"},{"key":"b4-peds13440","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1111\/j.1528-1167.2010.02522.x","article-title":"Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005\u20132009","volume":"51","author":"Berg","year":"2010"},{"key":"b5-peds13440","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1002\/ana.22427","article-title":"Acute ischemic stroke in children versus young adults","volume":"70","author":"Bigi","year":"2011"},{"key":"b6-peds13440","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1212\/WNL.59.1.129","article-title":"Intractable epilepsy in vascular congenital hemiparesis: clinical features and surgical options","volume":"59","author":"Carre\u00f1o","year":"2002"},{"issue":"2 Suppl Pediatrics","key":"b7-peds13440","series-title":"J Neurosurg","first-page":"125","article-title":"Cerebral hemispherectomy in pediatric patients with epilepsy: comparison of three techniques by pathological substrate in 115 patients","volume":"100","author":"Cook","year":"2004"},{"key":"b8-peds13440","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1914","DOI":"10.1056\/NEJMcp1107281","article-title":"Clinical practice. 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A survey among practicing neurologists","volume":"53","author":"Erba","year":"2012"},{"key":"b13-peds13440","series-title":"J Child Neurol","doi-asserted-by":"publisher","first-page":"1274","DOI":"10.1177\/0883073807307106","article-title":"Epilepsy in children with delayed presentation of perinatal stroke","volume":"22","author":"Fitzgerald","year":"2007"},{"key":"b14-peds13440","series-title":"Adv Pediatr","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.yapd.2009.08.003","article-title":"Pediatric stroke: past, present and future","volume":"56","author":"Friedman","year":"2009"},{"key":"b15-peds13440","series-title":"Pediatr Ann","doi-asserted-by":"publisher","first-page":"386","DOI":"10.3928\/0090-4481-20060501-11","article-title":"Surgery for epilepsy","volume":"35","author":"Ghatan","year":"2006"},{"key":"b16-peds13440","series-title":"J Pediatr","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.jpeds.2007.03.058","article-title":"Perinatal stroke and the risk of developing childhood epilepsy","volume":"151","author":"Golomb","year":"2007"},{"key":"b17-peds13440","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.1212\/01.wnl.0000247281.98094.e2","article-title":"Accuracy and yield of ICD-9 codes for identifying children with ischemic stroke","volume":"67","author":"Golomb","year":"2006"},{"key":"b18-peds13440","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1007\/s00381-006-0150-3","article-title":"Symptomatic epilepsy in children with poroencephalic cysts secondary to perinatal middle cerebral artery occlusion","volume":"22","author":"Guzzetta","year":"2006"},{"key":"b19-peds13440","series-title":"Epilepsy Behav","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.yebeh.2008.02.003","article-title":"A survey of neurologists' views on epilepsy surgery and medically refractory epilepsy","volume":"13","author":"Hakimi","year":"2008"},{"key":"b20-peds13440","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1111\/j.1528-1167.2011.03074.x","article-title":"Social outcomes after temporal or extratemporal epilepsy surgery: a systematic review","volume":"52","author":"Hamiwka","year":"2011"},{"key":"b21-peds13440","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1111\/j.1528-1167.2008.01945.x","article-title":"Is a first acute symptomatic seizure epilepsy? 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Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery","volume":"42","author":"Wieser","year":"2001"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/14\/1\/article-p58.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/14\/1\/article-p58.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/14\/1\/article-p58.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T15:59:31Z","timestamp":1681574371000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/14\/1\/article-p58.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,7]]},"references-count":39,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2014.3.peds13440","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,7]]}}}