Endovascular embolization for medically refractory pediatric epilepsy: a case series

Risheng Xu, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA rxu4@jh.edu.
Ethan Srinivasan, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Alice Hung, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Ryan Patrick Lee, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Liam Hughes, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Emily Johnson, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Connor Liu, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Lisa R. Sun, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Ryan J. Felling, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Anne Comi, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Siddarth Gupta, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Sarah Kelley, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Babitha Harida, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Carl Stafstrom, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Eric Kossoff, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Christa Habela, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Kristen Baranano, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Joseph Scafidi, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Sue Hong, Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Stacey Suskauer, Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
George Jallo, Department of Neurosurgery, Johns Hopkins School of Medicine, St. Petersburg, Florida, USA.
Matthew Smyth, Department of Neurosurgery, Johns Hopkins School of Medicine, St. Petersburg, Florida, USA.
Aylin Tekes, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Melike Guryildirim, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Doris Lin, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Alan Cohen, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Monica S. Pearl, Department of Radiology, Children's National Hospital, Washington, District of Columbia, USA.
Ahmad Marashly, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Shenandoah Robinson, Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Document Type

Journal Article

Publication Date

5-30-2025

Journal

Journal of neurointerventional surgery

DOI

10.1136/jnis-2025-023265

Keywords

Blood Flow; EEG; Liquid Embolic Material; Stroke; Vascular Malformation

Abstract

BACKGROUND: Endovascular embolization has been reported in limited case series and case reports as a minimally invasive option for managing refractory epilepsy, particularly in cases where traditional surgical interventions are high risk. OBJECTIVE: To explores the feasibility, safety, and outcomes of endovascular embolization in pediatric patients with intractable epilepsy due to varied etiologies. METHODS: This retrospective case series includes four pediatric patients with medically refractory epilepsy, who underwent staged endovascular embolization at a tertiary care center between 2022 and 2024. Patients were selected based on contraindications to conventional surgical approaches and failure of at least two anti-seizure medications. Outcome measures included seizure frequency reduction, functional improvements, and procedure-related complications. Follow-up duration ranged from 10 to 15 months after the last embolization. RESULTS: The cohort included four patients aged 2 to 9 years, and a total of 12 embolization procedures were performed. Three patients achieved freedom from seizures, while one undergoing a palliative procedure showed meaningful improvement in seizure frequency. No patients required rescue surgery, and none experienced hydrocephalus or neurologically unexpected complications during the follow-up period. Postprocedural deficits were similar to functional hemispherectomy outcomes. Parents and clinicians reported substantial developmental and functional improvements across multiple domains. CONCLUSIONS: Endovascular embolization is a promising minimally invasive strategy for pediatric patients with refractory epilepsy, particularly when anatomical or medical considerations preclude traditional surgery. Further research is warranted to refine patient selection criteria and assess long-term efficacy compared with established surgical approaches. This series expands the potential applications of endovascular techniques in epilepsy management.

Department

Radiology

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