The impact of sub specialization within functional neurosurgery on patient outcomes in a comprehensive epilepsy center

Austin JS Clark, Rikki Samuel, Ignacio Saez, Jeffrey Kennedy, Masud Seyal, Kiarash Shahlaie, Fady Girgis

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: One in three patients with epilepsy are medication-refractory and may benefit from investigations and operative treatment at a comprehensive epilepsy center. However, while these centers have capabilities for advanced seizure monitoring and surgical intervention, they are not required to have a functional neurosurgeon who is primarily focused in epilepsy surgery. Therefore, the objective of this study is to determine the impact of having a sub-specialized, epilepsy-focused functional neurosurgeon on patient outcomes. Methods: We 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 afterwards. We compared surgical procedures, significant complications, and seizure outcomes. Results: 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 percentage of cases undergoing iEEG, and no difference in complication rates. Conclusions: 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.

Original languageEnglish
Article number106636
JournalClinical Neurology and Neurosurgery
StatePublished - Jun 2021
Externally publishedYes


  • Comprehensive epilepsy center
  • Epilepsy
  • Epilepsy surgery
  • Functional neurosurgery
  • Sub-specialization


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