Sacramento, capital of the U.S. state of California.
Department of Neurosurgery, Kaiser Permanente Medical Group, 2025 Morse Ave., Sacramento, CA 95825, USA.
Department of Neurological Surgery, University of California, Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817.
While an epilepsy center has capabilities for advanced seizure monitoring and surgical intervention, they are not required to have a functional neurosurgeon who is primarily focused on epilepsy surgery. Therefore, the objective of a study by Clark et al. from the Department of Neurological Surgery Sacramento was to determine the impact of having a sub-specialized, epilepsy-focused functional neurosurgeon on patient outcomes.
They conducted a retrospective chart review for all patients who underwent surgical intervention for medically refractory epilepsy at a Level 4 Comprehensive Epilepsy Center from 2008 through 2019. Data was divided into two groups: group 1 comprised patients who had surgery before the hiring of a dedicated epilepsy-focused functional neurosurgeon in 2016, and group 2 was afterward. They compared surgical procedures, significant complications, and seizure outcomes.
A total of 101 patients underwent 105 operations (52 in group 1 and 53 in group 2), not including intracranial EEG insertion. Compared to group 1, group 2 had more surgeries performed per year (15.1 vs. 6.5), and a significantly lower Engel score at last follow-up (1.78 vs. 2.57; p < 0.001). There was no difference in the percentage of cases undergoing EEG, and no difference in complication rates.
In this series, the hiring of a sub-specialized functional neurosurgeon dedicated to epilepsy surgery in a comprehensive epilepsy center was associated with an increase in surgical volume and improved seizure outcomes 1).