{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T12:52:02Z","timestamp":1783774322051,"version":"3.55.0"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Resection is a safe and effective treatment option for children with pharmacoresistant focal epilepsy, but some patients continue experience seizures after surgery. While most studies of pediatric epilepsy surgery focus on predictors of postoperative seizure outcome, these factors are often not modifiable, and the reasons for surgical failure may remain unclear.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors performed a retrospective cohort study of children and adolescents who received focal resective surgery for pharmacoresistant epilepsy. Both quantitative and qualitative analyses of factors associated with persistent postoperative seizures were conducted.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Records were reviewed from 110 patients, ranging in age from 6 months to 19 years at the time of surgery, who underwent a total of 115 resections. At a mean 3.1-year follow-up, 76% of patients were free of disabling seizures (Engel Class I outcome). Seizure freedom was predicted by temporal lobe surgery compared with extratemporal resection, tumor or mesial temporal sclerosis compared with cortical dysplasia or other pathologies, and by a lower preoperative seizure frequency. Factors associated with persistent seizures (Engel Class II\u2013IV outcome) included residual epileptogenic tissue adjacent to the resection cavity (40%), an additional epileptogenic zone distant from the resection cavity (32%), and the presence of a hemispheric epilepsy syndrome (28%).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>While seizure outcomes in pediatric epilepsy surgery may be improved by the use of high-resolution neuroimaging and invasive electrographic studies, a more aggressive resection should be considered in certain patients, including hemispherectomy if a hemispheric epilepsy syndrome is suspected. Family counseling regarding treatment expectations is critical, and reoperation may be warranted in select cases.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.7.peds13658","type":"journal-article","created":{"date-parts":[[2014,8,15]],"date-time":"2014-08-15T16:42:41Z","timestamp":1408120961000},"page":"386-395","source":"Crossref","is-referenced-by-count":59,"title":["Epilepsy surgery failure in children: a quantitative and qualitative analysis"],"prefix":"10.3171","volume":"14","author":[{"given":"Dario J.","family":"Englot","sequence":"first","affiliation":[{"name":"UCSF Comprehensive Epilepsy Center and\u00a0"},{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seunggu J.","family":"Han","sequence":"additional","affiliation":[{"name":"UCSF Comprehensive Epilepsy Center and\u00a0"},{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Rolston","sequence":"additional","affiliation":[{"name":"UCSF Comprehensive Epilepsy Center and\u00a0"},{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Ivan","sequence":"additional","affiliation":[{"name":"UCSF Comprehensive Epilepsy Center and\u00a0"},{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel A.","family":"Kuperman","sequence":"additional","affiliation":[{"name":"Pediatric Epilepsy Program, Children's Hospital and Research Center Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward F.","family":"Chang","sequence":"additional","affiliation":[{"name":"UCSF Comprehensive Epilepsy Center and\u00a0"},{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalin","family":"Gupta","sequence":"additional","affiliation":[{"name":"UCSF Comprehensive Epilepsy Center and\u00a0"},{"name":"Departments of Neurological Surgery,"},{"name":"Pediatrics, University of California, San Francisco; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"UCSF Comprehensive Epilepsy Center and\u00a0"},{"name":"Neurology, and"},{"name":"Pediatrics, University of California, San Francisco; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurtis I.","family":"Auguste","sequence":"additional","affiliation":[{"name":"UCSF Comprehensive Epilepsy Center and\u00a0"},{"name":"Departments of Neurological Surgery,"},{"name":"Pediatrics, University of California, San Francisco; and"},{"name":"Pediatric Epilepsy Program, Children's Hospital and Research Center Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds13658","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.1111\/j.1528-1167.2011.03199.x","article-title":"Focal resection of fast ripples on extraoperative intracranial EEG improves seizure outcome in pediatric epilepsy","volume":"52","author":"Akiyama","year":"2011"},{"key":"b2-peds13658","series-title":"Brain","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1093\/brain\/awp025","article-title":"Role of subdural electrocorticography in prediction of long-term seizure outcome in epilepsy surgery","volume":"132","author":"Asano","year":"2009"},{"key":"b3-peds13658","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"e141","DOI":"10.1111\/j.1528-1167.2012.03524.x","article-title":"Focal cortical dysplasia type IIb in the rolandic cortex: functional reorganization after early surgery documented by passive task functional MRI","volume":"53","author":"Barba","year":"2012"},{"issue":"Suppl 2","key":"b4-peds13658","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":"b5-peds13658","series-title":"Epilepsy Res","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.eplepsyres.2008.04.020","article-title":"Enhanced EEG functional connectivity in mesial temporal lobe epilepsy","volume":"81","author":"Bettus","year":"2008"},{"key":"b6-peds13658","series-title":"Epilepsia","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1111\/j.1528-1167.2010.02777.x","article-title":"The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission","volume":"52","author":"Bl\u00fcmcke","year":"2011"},{"key":"b7-peds13658","series-title":"Acad Radiol","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.acra.2009.10.013","article-title":"Imaging of patients with hippocampal sclerosis at 7 Tesla: initial results","volume":"17","author":"Breyer","year":"2010"},{"key":"b8-peds13658","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"421","DOI":"10.3171\/2011.1.PEDS10348","article-title":"Bilateral invasive electroencephalography in patients with tuberous sclerosis complex: a path to surgery? 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