It is suggested that establishing routine FLE services in countries with limited resources is feasible, and a streamlined surgery pathway should be introduced, together with strengthening national capacity and adopting cost-efficient technology.
Abstract
Background: Frontal lobe epilepsy (FLE) surgery often requires complex presurgical evaluations and intraoperative monitoring, which may not be readily available in resource-limited settings. We report our experience establishing FLE surgical services in Indonesia to develop strategies for a simple but reliable service in low- and middle-income countries. Methods: We included patients who underwent FLE surgery between 2003 and 2023 in Semarang, Indonesia. These patients underwent surgery with at least 12 months of follow-up. Univariate and multivariate Firth penalized logistic regression analyses were performed to identify factors associated with surgical outcome, stratified by follow-up duration. Kaplan–Meier survival analysis and log-rank tests were performed to assess time-to-seizure recurrence across subgroups. Results: 87 FLE surgeries were performed over a period of 20 years. Approximately 60% of the patients were pediatric. Most patients (63.2%) showed visible focal cortical dysplasia on imaging. At the ≥5-year follow-up group, 56.8% of the patients had Engel Class I disease, with 79.3% have favorable (productive) functional outcomes. Among factors associated with postoperative outcomes, the number of anti-seizure medicines ≥3 was a significant seizure-free predictor at ≥5-year follow-up (odds ratio 0.18, 95% confidence interval 0.04–0.87, p = 0.033). The median seizure-free survival was 10.0 years for the overall cohort. Conclusion: Despite several limitations, this research suggests that establishing routine FLE services in countries with limited resources is feasible. To maintain a simple but reliable service, a streamlined surgery pathway should be introduced, together with strengthening national capacity and adopting cost-efficient technology.
INTRODUCTION
Epilepsy is a common pediatric neurologic disorder, and its surgical management has increased over time. To characterize longitudinal changes in patient selection, surgical approach and outcomes, we report a 30-year retrospective review at a high-volume level 4 epilepsy center.
METHODS
Consecutive epilepsy surgeries from 1989 to 2018 were analyzed and grouped into early (1989-2003) and late (2004-2018) 15-year eras. Demographic, clinical, radiographic, surgical, and 2-year Engel outcome data were collected and analyzed. Multivariable logistic regression assessed independent associations between era, patient characteristics, imaging findings, surgical procedures, and seizure outcomes.
RESULTS
Of 1241 surgical records, 1128 pediatric cases were included (415 early, 713 late; 55.50% male). Patients in the late era were older at surgery (10.27 vs. 8.53 years, p < .001), and repeat surgery was more common (p < .001). Focal (OR 1.72, p = .005) and cerebral insult related (OR 2.74, p < .001) MRI abnormalities were more frequently treated in the late era. Hemispherectomies, lobectomies and corpus callosotomies were performed less often (all p ≤ .001), while focal and multilobar resections remained stable (p > .05). Use of invasive monitoring and electrical stimulation mapping declined over time (p < .001). Seizure freedom rates were stable, however, ≥ 90% seizure reduction was more common in the late era (OR 1.60, p = .038).
CONCLUSION
Over three decades, pediatric epilepsy surgical volume increased, surgery shifted towards older patients, with reduced extensive resection and reduced reliance on invasive monitoring. Despite these changes, seizure freedom rates remained stable, with improved near-complete seizure control in the later era.
Shelly Wang, Puck C. Reeders, M. González et al.· Epilepsy Research· 0 citations
Long-term outcomes of epilepsy surgery: A 25-year experience from a tertiary referral center Almeida M, Barros F, Cunha I, Brás A, Teotónio R, Bento C, Sales F. Epileptic Disord. 2025 Dec;27(6):1217-1226. doi: 10.1002/epd2.70101. Epub 2025 Sep 6. PMID: 40913513; PMCID: PMC12747684. Objective: Despite pharmacological advances in epilepsy treatment, one-third of patients remain pharmacoresistant and may require surgery. Despite extensive literature on epilepsy surgery, studies with follow-ups longer than 5 years are rare. Our goal was to analyze the outcomes of patients undergoing epilepsy surgery at our center, with a minimum follow-up of 15 years. Methods: This was a retrospective study of prospectively collected data. We used the Engel classification to assess seizure freedom, performed univariate descriptive analysis of the variables of interest, and applied appropriate correlation tests for nominal and categorical variables, with statistical significance set at 0.05. Results: We included 160 patients with a minimum follow-up of 15 years. A total of 105 (70%) patients underwent resective surgeries, the most common being lesionectomy (46.7%), followed by anterior temporal lobectomy with amygdalectomy (21.9%). Among resective surgeries, 73.6% used intraoperative ECOG. Most surgeries were in the temporal lobe (68.8%), and mesial sclerosis was the most frequent etiology (33.8%), followed by long-term epilepsy-associated tumors (LEAT) (25.6%). Seizure freedom at 15 years was achieved by 57.5% of patients, and most of the remaining patients (63.2%) had rare disabling seizures. The majority (65%) discontinued at least 1 ASM. Temporal surgeries (χ2(1) = 8.444, P < .05), left-sided surgeries (χ2(1) = 6.436, P = .04), mesial sclerosis (χ2(1) = 50.870, P = .024), and the use of intraoperative ECOG (χ2(1) = 23.235, P < .001) were associated with a better prognosis. No differences in outcome were found between the different temporal lobe surgeries (Fisher's exact test value=0.859, P = .659). Significance: Appropriate referral to a refractory epilepsy center permits a multidisciplinary approach that can result in long-term seizure freedom for most patients undergoing surgery, especially for left-temporal lobe surgeries performed with the aid of intraoperative monitoring techniques.
Abstract Background and Objective Cerebellar brain metastases (BM) present unique clinical challenges due to their critical location and association with hydrocephalus and hemorrhage. Surgical resection remains an essential treatment, but real-world outcome data in the modern systemic therapy era are limited. Methods We retrospectively analyzed 201 patients who underwent resection of cerebellar metastases between 2017 and 2024 across four tertiary care centers. Baseline clinical characteristics, postoperative Karnofsky Performance Status (KPS), Graded Prognostic Assessment (GPA), hydrocephalus (clinical and radiological), hemorrhage status, and extracranial disease were collected. Overall survival (OS) was estimated using Kaplan–Meier analysis. Median survival with 95% confidence intervals (CI) was calculated using bootstrap resampling. Spearman correlation was applied to assess associations between clinical variables. Results The cohort included 52% males and 48% females, with a median age of 65 years. Clinical hydrocephalus was present in ∼30%, and radiological hydrocephalus in ∼35%. Hemorrhagic metastases occurred in ∼25%, while 10% presented with massive intracranial hemorrhage. Postoperative KPS ≥ 70 was achieved in the majority (65%). At last follow-up, ∼65% of patients were deceased. Median OS was 11.2 months (95% CI: 9.4–13.1). One-year survival was 47%, and two-year survival was 25%. Prognosis was significantly influenced by postoperative KPS, GPA, presence of extracranial metastases, and clinical hydrocephalus at baseline. Spearman correlation demonstrated strong associations between tumor and edema volume (p = 0.29) as well as tumor volume and clinical hydrocephalus (p = 0.58), whereas radiological hydrocephalus correlated only weakly with clinical hydrocephalus (p = 0.07). Conclusions In this contemporary multicenter cohort of 201 patients, surgical resection of cerebellar metastases achieved a median survival of about one year. Functional status and systemic disease burden remain the strongest predictors of outcome. These data provide a modern benchmark for clinical decision-making and trial design in patients with cerebellar BM.
T. Araceli, Matthias Demetz, J. Rösler et al.· Neuro-Oncology Advances· 0 citations
OBJECTIVE
To examine the impact of the operated brain region and clinical-surgical variables on intellectual performance in children and adolescents undergoing neurosurgery for pharmacoresistant epilepsy.
METHODS
Fifty-one participants were classified according to surgical site: temporal lobe (TL; n = 23), frontal lobe (FL; n = 9), posterior cortex (PC; n = 9), and hemispherotomy (H; n = 10). Neuropsychological assessment was performed using age-appropriate versions of the Wechsler Intelligence Scales (Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale [WISC/WAIS]). Bayesian linear mixed models compared intelligence quotients and scale indices across three time points: preoperative (T0), 6-month postoperative (T1), and 24-month postoperative (T2). For each outcome, two models were fitted: a simple model and a multiple model adjusted for seizure frequency and epilepsy duration. Estimates were derived from posterior distributions with 95% credibility intervals. Analyses were conducted in R using MCMC sampling, with convergence assessed by trace plots and the Gelman-Rubin diagnostic. A change of ≥10 points was considered a clinically relevant improvement, whereas a decrease of ≥5 points indicated a relevant decline in longitudinal within-group comparisons. Results reflect group-level trajectories rather than individual outcomes.
RESULTS
At T1, the H group showed declines in Full-Scale Intelligence Quotient (FSIQ), Verbal Comprehension Index (VCI), Perceptual Organization Index (POI), Working Memory Index (WMI), and Processing Speed Index (PSI). At T2, the FSIQ, POI, and WMI returned to near baseline, whereas VCI and PSI remained reduced. The TL group showed declines in VCI, WMI, and PSI at T1, with a persistent reduction in VCI at T2. FL and PC groups maintained intelligence indices close to baseline at both postoperative assessments.
SIGNIFICANCE
Epilepsy surgery preserved intellectual functioning, particularly in FL and PC procedures. However, persistent VCI decline in H and TL groups suggests effects on verbal abilities associated with temporal lobe involvement. Sustained PSI reduction after hemispherotomy may indicate decreased cognitive efficiency and slower information processing.
Geisa de Angelis, L. E. Lopes-Santos, D. Aragon et al.· Epilepsia· 0 citations
Abstract Objective Epileptic spasms (ES) in children carry a high risk of neurodevelopmental delay, yet predictors of long‐term surgical outcome remain incompletely defined. This study aimed to evaluate seizure outcomes following epilepsy surgery and to identify independent prognostic factors for postoperative recurrence. Methods This retrospective cohort study included 73 patients (47 males, 64%; median age at surgery: 37 months, IQR: 20–55.5) with drug‐resistant ES who underwent resective or ablative surgery at Guangdong Sanjiu Brain Hospital in China between January 2015 and September 2024, with regular follow‐up at least 12 months after epilepsy surgery. Independent predictors of recurrence were identified using multivariate Cox proportional hazards regression, and Kaplan–Meier analysis was performed to compare seizure‐free survival stratified by seizure duration (SD) and residual lesion status. Results Seizure‐free rates were 75.3% at 1 year and 55.1% at last follow‐up. Mean follow‐up was 61.36 ± 26.10 months (range: 12–132). Among malformation of cortical development (MCD) subtypes, focal cortical dysplasia (FCD) type II demonstrated the highest 5‐year seizure‐free rate (100%), whereas mild MCD (m‐MCD) showed the lowest (33.3%; p = 0.039). On multivariate Cox analysis, residual lesion on postoperative MRI was the strongest independent predictor of recurrence (HR = 5.13; 95% CI: 2.28–11.51; p < 0.001), followed by SD exceeding 36 months (HR = 2.49; 95% CI: 1.17–5.29; p = 0.018). Kaplan–Meier analysis confirmed a twofold difference in 5‐year seizure‐free survival between patients with duration ≤36 versus >36 months (73% vs. 36%; log‐rank p = 0.00069), and significantly better seizure‐free survival in patients without residual lesions (log‐rank p < 0.0001). Significance Complete lesion resection and early surgical intervention (SD ≤36 months) are independently associated with favorable long‐term seizure outcomes in children with drug‐resistant ES. Pathological subtype, particularly FCD type II, further refines prognostic stratification. These findings support prompt surgical referral and underscore the importance of achieving complete lesion removal to optimize postoperative seizure control. Plain Language Summary Some children develop a severe form of epilepsy called epileptic spasms that cannot be controlled with medication. In this study of 73 children who had brain surgery for this condition, more than half remained seizure‐free after 5 years. Children who had surgery earlier—before seizures had continued for 3 years—and those in whom the entire abnormal brain tissue was removed did significantly better in the long run. These findings suggest that referring children for surgery sooner rather than later can meaningfully improve their chances of living seizure‐free.
Hua Li, Yao Wang, Qiang Guo et al.· Epilepsia Open· 0 citations
Background: Glioblastoma (GBM) is the most aggressive primary brain tumor, causing neurological symptoms and requiring MRI-guided surgery followed by radiotherapy and temozolomide. Despite treatment, prognosis remains poor, with a median survival of about 14 months, though outcomes improve with younger age, maximal safe resection, and completion of therapy. Advanced imaging may improve prognostic assessment, but data from low-resource settings remain limited. Methods: A 5-year forward-looking study (2021–2026) at Dhaka Medical College Hospital and Green Life Hospital involved 30 patients with supratentorial glioblastoma who underwent maximal safe resection along with standard chemoradiotherapy. Patients underwent clinical and MRI evaluations, and survival analysis was conducted using the Kaplan–Meier method. Approval from the ethics committee and informed consent were secured Results: Fifteen patients diagnosed with supratentorial glioblastoma (average age 54.2 years) primarily exhibited headaches, seizures, and focal deficits. The majority had frontal tumors, lesions that did not cross the midline, and received gross total resection followed by chemoradiotherapy. The median overall survival time was 16.4 months, and the 5-year survival rate was 20% (6 out of 30). Improved outcomes were linked to gross total resection, tumors located away from the midline, completion of treatment, and positive MRI characteristics Conclusion: Supratentorial glioblastoma has a grim outlook even with combined treatment approaches. Improved survival correlates with gross total resection, thorough chemoradiotherapy, non-midline tumor positioning, and positive MRI characteristics, emphasizing the significance of extensive safe surgery and advanced imaging for predicting outcomes.
Journal of Paediatric Surgeons of Bangladesh (2026) Vol. 17 (1): 73-77
Muhammad Shahriar Kabir, Mohammed Hasnayen Faisal, Tammana Zahan· Journal of Paediatric Surgeo...· 0 citations