The results of surgery for extratemporal partial epilepsy that began in childhood are reported from the Department of Surgery, Stanford University Medical School; Department of Neurology, University of Rochester; University of Colorado Health Sciences Center; and the Children’s Hospital, Boston MA. Of 35 patients who underwent 39 operations, 63% were either seizure-free or had a significant reduction in frequency of seizures. The locations of the cortical resections were frontal, parietal, occipital, or multilobar. Tumors accounted for 31%, malformation 17%, atrophy 14%, encephalitis 5.7%, Sturge-Weber syndrome, 2.9%, and vascular malformation 8.6%. The lesion was a nonspecific gliosis in 20%. Patients for surgery were selected by clinical criteria, neural imaging, and EEG with long-term monitoring. Invasive preoperative investigations such as depth electrodes were not employed. The authors advocate early operation in children with intractable epilepsy even when the seizure focus is not involving the temporal lobe. 
COMMENT. In retrospect the authors believed that surgery was delayed in most patients much longer than necessary and that years of needless suffering from epilepsy and the adverse effects of antiepileptic medications might have been avoided by surgery before adolescence. Patients with vascular malformations often had the longest delay between onset of seizures and surgery and these would have benefitted greatly from earlier intervention.