Safety and Efficacy of Disconnective Surgery in Children with Medically Intractable Epilepsy Secondary to Neonatal Hypoglycemia: A Case Series of 25 Patients

Objective: Neonatal hypoglycemic brain injury (NHBI) is an underrecognized cause of disabling drug-resistant childhood epilepsy, with limited surgical outcome data. We aimed to analyze seizure control, neurocognitive safety, and complication rates after disconnective procedures in pediatric NHBI epilepsy. Methods: In this prospective cohort, children ≤ 18 years with drug-resistant epilepsy and magnetic resonance imaging (MRI)-confirmed NHBI underwent epilepsy surgery between November 2023 and March 2025 (single center, Jaipur, Rajasthan, India). Presurgical workup included 3-Tesla MRI, prolonged video-electroencephalography, neuropsychology, and visual field assessment. Patients with alternative epileptogenic substrates were excluded. Surgical procedures included temporo-parieto-occipital disconnection (TPO), parieto-occipital disconnection (PO), TPO with additional focal resection (TPO+), and complete corpus callosotomy (CC). Postoperative seizure outcome (Engel classification), complications, and postsurgery visual morbidity were recorded at 12 months. Results: Twenty-five of 71 pediatric epilepsy surgeries met the inclusion criteria (median age 8 years; 15 females). Ten children underwent TPO, four PO, three TPO+, and eight CC. Seizure-freedom rates at 12 months were highest following TPO (9/10, 90%), versus 3/4 (75%) for PO, 1/3 (33.3%) for TPO+, and 5/8 (62.5%) after CC (overall 72% Engel class I). Postoperative complications (4/25, 16%) were mild and nondisabling; notably, no new visual field deficits or major cognitive deterioration was observed. Conclusion: This is one of the first prospective pediatric data sets specifically evaluating disconnective epilepsy surgery for NHBI. TPO disconnection demonstrated excellent seizure freedom with minimal morbidity, suggesting it may be the optimal surgical strategy for this population. These findings support early surgical consideration and justify a multicenter study to confirm these excellent results. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India