Epilepsy Surgery in a Resource-Limited Latin-American Center: Presurgical Evaluation Findings and Early ILAE Outcomes in a Mixed Adult-Pediatric Cohort

Background: Resource-constrained programs perform epilepsy surgery under limited access to advanced imaging and neuromodulation. We describe presurgical evaluation findings, early seizure outcomes, and safety from a mixed adult-pediatric cohort. Methods: Retrospective single-center series of 22 consecutive patients meeting surgical candidacy. We captured demographics, epilepsy classification/etiology, presurgical investigations (long-term Video-EEG, MRI, selective FDG-PET), procedure type, histopathology when available, and postoperative seizure outcome (ILAE). Complications were recorded using the ILAE adverse-event taxonomy. Results: Mean age at surgery was 21.2 ± 11.2 years; 15 (68%) were male. Epilepsy was focal in 15 (68%); structural etiologies predominated in 15 (68%). MRI was concordant with the presumed epileptogenic zone in 13 (59%). FDG-PET was obtained in 10 (45.5%) and was concordant in 7 (70%). Long-term Video-EEG (≥2 habitual seizures) was completed in 21. Mean delay to surgery was 10 years (IQR [8–15]); presurgical work-up averaged 10 months (IQR [6–15]). Procedures were resective 14 (64%), disconnective 6 (27%), and neuromodulatory 2 (9%). Histopathology was available in 16 cases, most commonly showing hippocampal sclerosis (n = 5) and focal cortical dysplasia (n = 5). At 14 months median follow-up (range 12–34), ILAE outcomes were: I 41% (9), II 14% (3), III 23% (5), IV 23% (5). Outcomes significantly differed by procedure: curative-intent (resection/disconnection) achieved ILAE I 60% (9) versus ILAE III/IV 7 after palliative-intent (corpus callosotomy/neuromodulation). No deaths or permanent deficits occurred; one corpus callosotomy case developed transient aseptic meningitis. Conclusions: In a resource-limited program, structured presurgical evaluation and careful selection yield resection/disconnection outcomes comparable to high-resource benchmarks, while corpus callosotomy/neuromodulation remain largely palliative. Practical, reproducible pathways may help shorten delays and improve access in similar settings.