Abstracts

Rationale: Frequency of seizures in children with hydrocephalus varies from 25to 75% in the literature implicating the underlying pathology, or the treatment itself including cortical injury from shunt insertion and shunt related complications such as infection. Though some retrospective studies discuss persistence of seizures in this population, there is little mentioned on more aggressive therapies such as epilepsy surgery. We describe our patient population with both intractable epilepsy and shunted hydrocephalus who underwent epilepsy surgery Methods: A retrospective study was performed at Rainbow Babies & Children s Hospital with IRB approval. The records of all children who underwent intracranial surgery for intractable seizures through the Rainbow Comprehensive Pediatric Epilepsy Center were reviewed from 2000 to 2009. All patients with intracranial shunts at time of epilepsy surgery were identified. Pertinent clinical data from medical charts, video-EEG reports, imaging and neuropsychological studies was collected. Follow-up was from the most recent clinic visit or other contact. Results: Four children with intractable epilepsy and shunted hydrocephalus underwent invasive monitoring to guide resection of their seizure foci. Demographics and etiologies of both shunts and seizures are summarized in Table 1. All had neonatal seizures or seizures in the acute post-injury period, and subsequently developed hydrocephalus treated with shunts. Seizures recurred between 2 and 9 years of age and persisted despite multiple medications. Epilepsy surgery was performed 4 to 8 years after seizure recurrence. All 4 patients had craniotomies on the hemisphere that contained the shunt. Three had two small craniotomies at the time of electrode insertion to avoid disturbing the shunt hardware. Two patients had undergone >10 shunt revisions prior to epilepsy surgery, both have complex shunts with 2 intracranial catheters Y'd together. One of 4 patients needed a shunt revision for the first time more than 1 year after epilepsy surgery, and subsequently had 3 more revisions. There were no shunt infections or other shunt-related complications. While 2 patients had additional resection 1 year after initial surgery, seizure freedom persists post-operatively at 5 years in 2 patients. Conclusions: Though intracranial shunts may be associated with seizures, they were not part of the assessed epileptogenic zone in our patients. Besides the shunt itself, this patient population has etiologies and comorbidities often predetermined as criteria for suboptimal epilepsy surgery outcomes. Though the numbers are small, our results show that successful outcomes can be achieved in children with intractable epilepsy and intracranial shunts.