Pediatric Epilepsy Surgery: Global Survey of Surgical Approaches

BACKGROUND AND OBJECTIVES: Pediatric epilepsy surgery is an established treatment, but current global data on surgical practices are limited. This study, conducted by the International League Against Epilepsy Pediatric Epilepsy Surgery Taskforce, provides an updated international overview of surgical approaches and their regional variation. METHODS: Group-level data were collected from 61 epilepsy surgery programs (49 pediatric-only) across 29 countries on 6 continents. All children and adolescents who underwent epilepsy surgery in 2023 were included. The study was designed to enable direct comparison with the similar survey conducted by the International League Against Epilepsy in 2004. RESULTS: The cohort comprised 2427 patients. Resections accounted for 50.6% and disconnections for 23.0% of procedures. Resection rates were highest in Oceania (87.3%) and lowest in North America (40.3%). Resections were 43.0% unilobar-most commonly temporal (39.6%) and frontal (32.7%)-and 9.7% multilobar, with 61.9% involving the posterior quadrant. Hemispheric surgeries comprised 12.9% of all cases (highest in South America: 18.1%). Subcortical procedures (eg, for hypothalamic hamartomas or deep-seated lesions) represented 2.7% (highest in South America: 12.1%). Intraoperative electrocorticography was used in 38.3% of cases, most commonly in Oceania (84.1%) and Asia (85.5%). Minimally invasive techniques were used in 7.7% of cases, with the highest rate in North America (16.9%). Laser interstitial thermal therapy was most common (4.9%), followed by radiofrequency ablation (2.1%), endoscopic surgery (0.7%), and radiosurgery (0.1%). Corpus callosotomy was performed in 5.9% of all cases, and no multiple subpial transections were reported. Neurostimulation was used in 14.7% of patients, highest in North America (35.6%), and included vagal nerve stimulation (11.8%), deep brain stimulation (1.5%), and responsive neurostimulation (1.4%). CONCLUSION: Resections and disconnections, including extensive multilobar and hemispheric procedures, remain the core procedures of pediatric epilepsy surgery. Although minimally invasive and neuromodulatory techniques are increasingly used in selected regions-particularly North America-their global adoption remains limited.

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Journal
Neurosurgery
Published
2026-11-03
DOI
https://doi.org/10.1227/neu.0000000000004282
Primary Topic
Epilepsy research and treatment
Type
article
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article

Pediatric Epilepsy Surgery: Global Survey of Surgical Approaches

Aria Fallah, Martin M. Tisdall, Luca De Palma, Cristine Mella Cukiert et al.
Neurosurgery
Epilepsy research and treatment
article

Pediatric Epilepsy Surgery: Global Survey of Surgical Approaches

Aria Fallah, Martin M. Tisdall, Luca De Palma, Cristine Mella Cukiert, Matt Lallas, Jonathan F. Roth, Dezhi Cao, Manjari Tripathi, Nico Enslin, Ahsan Mossa-Naduvil, Anthony Simon Harvey, Arthur Cukiert, Deepak S. Gill, Alexis A. Arzimanoglou, Lixin Cai, Daniel J. Curry, Masaki Iwasaki, Roberto Horacio Caraballo, Tom Pieper, Oscar Zorro Guio, Georgia Ramantani, Thilo Kalbhenn, T Hallböök, Dorottya Cserpán, Takayuki Kikuchi, Elaine C. Wirrell, Martha Feucht, Takehiro Uda, Howard L. Weiner, William E. Bingaman, Naotaka Usui, Richard Joseph Burman, Kensuke Kawai, Lakshminarayanan Kannan, Georg Dorfmüller, Noritsugu Kunihiro, Hans Holthausen, J. Aparicio, Carolina Muñoz‐Castro, Muhammad Zubair Tahir, Sandeep Bhagwan Patil, Dario Englot, Niklaus Krayenbühl, on behalf of ILAE Pediatric Epilepsy Surgery Taskforce and Study Group, Yuwu Jiang, Judith Helen Cross, Mary Lou Smith, Sarah Ferrand Sorbets, Kees Braun
article en

Abstract

BACKGROUND AND OBJECTIVES: Pediatric epilepsy surgery is an established treatment, but current global data on surgical practices are limited. This study, conducted by the International League Against Epilepsy Pediatric Epilepsy Surgery Taskforce, provides an updated international overview of surgical approaches and their regional variation. METHODS: Group-level data were collected from 61 epilepsy surgery programs (49 pediatric-only) across 29 countries on 6 continents. All children and adolescents who underwent epilepsy surgery in 2023 were included. The study was designed to enable direct comparison with the similar survey conducted by the International League Against Epilepsy in 2004. RESULTS: The cohort comprised 2427 patients. Resections accounted for 50.6% and disconnections for 23.0% of procedures. Resection rates were highest in Oceania (87.3%) and lowest in North America (40.3%). Resections were 43.0% unilobar-most commonly temporal (39.6%) and frontal (32.7%)-and 9.7% multilobar, with 61.9% involving the posterior quadrant. Hemispheric surgeries comprised 12.9% of all cases (highest in South America: 18.1%). Subcortical procedures (eg, for hypothalamic hamartomas or deep-seated lesions) represented 2.7% (highest in South America: 12.1%). Intraoperative electrocorticography was used in 38.3% of cases, most commonly in Oceania (84.1%) and Asia (85.5%). Minimally invasive techniques were used in 7.7% of cases, with the highest rate in North America (16.9%). Laser interstitial thermal therapy was most common (4.9%), followed by radiofrequency ablation (2.1%), endoscopic surgery (0.7%), and radiosurgery (0.1%). Corpus callosotomy was performed in 5.9% of all cases, and no multiple subpial transections were reported. Neurostimulation was used in 14.7% of patients, highest in North America (35.6%), and included vagal nerve stimulation (11.8%), deep brain stimulation (1.5%), and responsive neurostimulation (1.4%). CONCLUSION: Resections and disconnections, including extensive multilobar and hemispheric procedures, remain the core procedures of pediatric epilepsy surgery. Although minimally invasive and neuromodulatory techniques are increasingly used in selected regions-particularly North America-their global adoption remains limited.

Neurosurgery
Hospital Sant Joan de Déu Barcelona (ES), Cleveland Clinic (US), Royal Children's Hospital (AU), Mayo Clinic (US), Jichi Medical University (JP), University of Cape Town (ZA), University of California, Los Angeles (US), Tel Aviv University (IL), Baylor College of Medicine (US), Utrecht University (NL), Bielefeld University (DE), University of Zurich (CH), Kyoto University (JP), Pontificia Universidad Javeriana (CO), Tel Aviv Sourasky Medical Center (IL), Garrahan Hospital (AR), Great Ormond Street Hospital (GB), Great Ormond Street Hospital for Children NHS Foundation Trust (GB), Sahlgrenska University Hospital (SE), Hospital for Sick Children (CA), Gleneagles Hospital (SG), Children's Hospital at Westmead (AU), Westmead Hospital (AU), University Medical Center Utrecht (NL), ETH Zurich (CH), Schön Klinik Vogtareuth (DE), National Epilepsy Center (JP), Osaka City General Hospital (JP), National Center of Neurology and Psychiatry (JP), Deenanath Mangeshkar Hospital and Research Center (IN), Hospital Regional de Concepción (CL), Bambino Gesù Children's Hospital (IT), University Children's Hospital Zurich (CH), Peking University First Hospital (CN), Miami Children's Hospital (US), Mayo Clinic in Florida (US), Texas Children's Hospital (US), Shenzhen Children's Hospital (CN), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Hospital Universitario San Ignacio (CO), Red Cross War Memorial Children's Hospital (ZA), The Neurological Institute (US), Osaka Metropolitan University (JP), National Center Hospital of Neurology and Psychiatry (JP), University College London (GB), All India Institute of Medical Sciences (IN), Medical University of Vienna (AT), Vanderbilt University Medical Center (US)
Openalex Percentile: Top 14%
Epilepsy research and treatment
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