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Research paper
Surgery in patients with childhood-onset epilepsy: analysis of complications and predictive risk factors for a severely complicated course
  1. Piergiorgio d'Orio1,
  2. Michele Rizzi1,2,
  3. Valeria Mariani1,
  4. Veronica Pelliccia1,
  5. Giorgio Lo Russo1,
  6. Francesco Cardinale1,
  7. Michele Nichelatti3,
  8. Lino Nobili1,4,
  9. Massimo Cossu1
  1. 1 "Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
  2. 2 Department of Neuroscience, University of Parma, Parma, Italy
  3. 3 Service of Biostatistics, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milano, Italy
  4. 4 Child Neuropsychiatry Unit, DINOGMI, University of Genoa, Genoa, Italy, Istituto Giannina Gaslini, Genova, Italy
  1. Correspondence to Dr Massimo Cossu, “Claudio Munari” Center for Epilepsy Surgery, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan 20162, Italy; massimo.cossu{at}


Object To compare the occurrence of surgery-related complications in patients with childhood-onset focal epilepsy operated on in the paediatric or in the adult age. To investigate risk factors for surgery-related complications in the whole cohort, with special attention to age at surgery and severe morbidity.

Methods A cohort of 1282 patients operated on for childhood-onset focal epilepsy was retrospectively analysed. Occurrence of surgery-related complications, including a severely complicated course (SCC: surgical complication requiring reoperation and/or permanent neurological deficit and/or death), was compared between patients operated on in the paediatric age (<16 year-old; 452 cases) and, respectively, in adulthood (≥16 year-old; 830 cases). The whole cohort of patients was also evaluated for risk factors for a SCC.

Results At last contact (median follow-up 98 months), 74.5% of patients were in Engel’s class I (78.0% of children and 73.0% of adults). One hundred patients (7.8%) presented a SCC (6.4% for children and 8.6% for adult patients). Postoperative intracranial haemorrhages occurred more frequently in adult cases. At multivariate analysis, increasing age at operation, multilobar surgery, resections in the rolandic/perirolandic and in insulo-opercular regions were independent risk factors for a SCC.

Conclusions Surgery for childhood-onset focal epilepsy provides excellent results on seizures and an acceptable safety profile at any age. Nevertheless, our results suggest that increasing age at surgery is associated with an increase in odds of developing severe surgery-related complications. These findings support the recommendation that children with drug-resistant, symptomatic (or presumed symptomatic) focal epilepsy should be referred for a surgical evaluation as early as possible after seizure onset.

  • epilepsy
  • childhood-onset epilepsy
  • epilepsy surgery
  • complications.

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  • Contributors Study design: PdO, MR, MC. Data collection: PdO, MR, VM, VP. Data analysis and interpretation: PdO, MR, MC, FC, MN. Statistical analysis: PdO, FC, MN. Drafting the article: PdO, MC. Critical revision of the article: GLR, LN, MC. Final approval of the version to be published: all the authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Comitato Etico Milano Area 3.

  • Provenance and peer review Not commissioned; externally peer reviewed.