Child's Nerv Syst (1996) 12:474-504 9 Springer-Verlag 1996 XV Congress of the European Society for Paediatric Neurosurgery, Rome, Italy, 23- 25 September 1996 The Multidisciplinary Aspects of Paediatric Neurosurgery Monday 23 September Afternoon Epilepsy: surgical perspectives and techniques Candidacy for epilepsy surgery: special considerations in chil- dren. M. Bourgeois, C. Sainte-Rose, J. Aicardi (Paris) Epilepsy surgery in children is a new field. An important practical issue has been the better definition of the optimum timing of epilep- sy surgery and the most suitable candidates for operation. A series of 138 children aged from 1 to 15 years (mean 8.8 years) who under- went surgery for severe epilepsy with focal lesions was retrospec- tively analysed to identify factors that interfered with normal brain development. Age of onset, duration and frequency of seizures, and intractability and semiology were each correlated with cognitive, be- havioural and educational status pre- and postoperatively. Multivar- iate analysis showed a close correlation between cognitive functions and duration of epilepsy prior to surgery, while behavioural disor- ders were more closely correlated with seizure frequency. After sur- gical control of epilepsy, the improvement in behavioural disorder was more significant (27.8%) than that in cognitive function (14.5%). These data must be taken into account when patients are selected for surgical treatment and the timing of the operation is discussed. Ear- ly surgery allows for optimal brain development. Trends in surgical treatment of pediatric epilepsy in Japan. K. Moritake, J. Hatta, Y. Matsumoto (Shimane) The numbers of all surgical cases and all pediatric surgical cases treated in the main institutions performing epilepsy surgery in Japan over a 10-year period are studied. These numbers have increased an- nually over the past decade, reflecting the growing interest of neu- rosurgeons in the surgical treatment of epilepsy and also the intro- duction of MRI and other newly developed diagnostic tools, which have made it possible to locate epileptogenic lesions that were pre- viously not identifiable. The annual number of papers on surgical treatment of epilepsy presented at the Penfleld Memorial Sympo- sium and the annual meeting of the Japanese Society for Pediatric Neurosurgery also bears this out. Until recently, papers on this top- ic remained rare, but over the past few years they have begun to in- crease in number. Papers on the surgical treatment of pediatric epi- lepsy first appeared in around 1989 and since then they have contin- ued to account for a considerable proportion of the presentations. These data also demonstrate the increasing interest of neurosurgeons in the use of surgery for the treatment of intractable epilepsy in chil- dren. It is estimated that in Japan about 100,000 patients with intrac- table epilepsy will become free of seizures. It is anticipated that intractable epilepsy will also be treated at centers in which surgery has not previously been used in epilepsy, thanks to the development of noninvasive or less invasive methods of localizing epileptogenic lesions. Children presenting with epilepsy as the first symptom of a brain tumor. K. Murseh, J. Behnke, H.-J. Christen, E. Markakis (G6ttin- gen) Between June 1987 and June 1995, we operated upon 1335 patients suffering from intracranial tumors, 175 of whom were younger than 17 years. These patients included 250 out of 1169 adults (21%), but also 21 out of 166 children (12%) who presented with seizures on admission. We report in particular findings in these 21 children com- pared with the children without seizures. The group suffering from seizures consisted of 15 boys and 6 girls with a median age of 5 years, and in the non-seizure group there were 78 boys and 67 girls with a median age of 6 years. All the tumors causing seizures involved su- pratentorial structures; the main lobe affected was the temporal lobe, which was affected in 17 children with seizures (80%) but only in 11 (7%) of the 145 children without seizures. The histological find- ings in the children suffering from seizures were mostly benign: 1 grade I astrocytoma, 3 grade II astrocytomas, 2 grade II oligoden- drogliomas, 4 gangliogliomas, 2 PNETs and 9 different space-occu- pying lesions, including a granuloma, and a plexus papilloma. After a minimum follow-up period of 1 year (maximum 9 years), 16 of the children are still alive, 15 of them without seizures. Mainly because of their benign histopathology and localization, tumors that cause seizures in childhood carry a good prognosis. Treatment of epileptic patients using intracerebral embryonal tissue transplantation. V. P. Bersnev, T. S. Stepanova, V. N. Oveeh- ko, V. A. Otellin (St. Petersburg) Reconstructive surgery was indicated in patients with severe epilep- tic seizures associated with cerebro-organic motor syndromes ac- companied by a marked atrophic process involving both cortical and subcortical structures. Currently 38 surgical patients aged 2-15 years are being followed up. The etiologic factors recorded are birth trauma, postnatal craniocerebral trauma, neuroinfection, vascular disorders, and asphyxia at delivery. Generalized seizures were ob- served in 27 patients, and focal seizures in 11. The seizure frequen- cy varied from 1 or 2 per year to 3-5 per day. The majority of the patients had various degrees of emotional and mnestic disturbance, some with mental retardation. Morphological brain changes, e.g. vol- ume and localization, were quantified using CT and MRI. Multiple subarachnoid cysts were revealed in one-third of these cases. Em- bryonal neural tissue (ENT) was taken intraoperatively during a mi-