445 - Surgical Treatment of Seizures in Children

K ristina “K risti ” R ae H ughes , cst , mha The modern era of epilepsy surgery began in 1886, at the National Hos- pital for Paralysed and Epileptic in London (Meador, Loring, & Flanigin, 1989). Sir Victor Horsley was the first to successful perform a cranioto- my for focal seizures secondary to a depressed skull fracture (Meador, Loring, & Flanigin, 1989). The enhanced modern interventions are a result of these earlier dated techniques and the beginning of the col- laboration between epilepsy surgery and neuroscience. Surgical Treatment of Seizures in Children L E ARNING OB J EC T I VES s Compare and contrast the various surgical techniques/approaches for treatment s Understand relevant anatomy and pathophysiology related to seizure activity/epilepsy s Recall and understand the key concepts and procedural steps for the Certified Surgical Technologist (CST) s Review the most common equipment and supplies used for an open craniotomy for focal cortical resection s Evaluate important post-operative considerations and potential complications S urgical interventions may be a last resort for children with epilepsy. While there are many pharmaceutical advance- ments that have been made, surgical intervention may be necessary to improve the patient’s quality of life. New antiepileptic drugs (AEDs), introduced since 1993, provide more diverse options in the treatment of epilepsy (Hwang & Kim, 2008). Even with these drugs being developed and improved over time, more than 25% of patients remain resistant to even the most advanced drug therapies (Hwang & Kim, 2008). A patient is a candidate for surgical inter- vention when there is inadequate seizure control despite appropri- ate medical therapy with at least two AEDs in maximally tolerated doses for 18 months to 2 years, or adequate seizure control with unacceptable drug related side effects (Go & Snead, 2008). In addition to pharmaceutical advancements, there are improve- ments that have been made in surgical treatment in patients with epilepsy. Historically, surgical treatment involves an open craniot- JANUARY 2021 | The Surgical Technologist | 19