Neurosurgery for pediatric epilepsy: Evidence from a systematic review on neuropsychological, cognitive, and behavioral outcomes

Objective: This systematic review aimed to assess the neuropsychological, cognitive, and behavioral outcomes in children and adolescents with drug-resistant epilepsy undergoing resective surgery. While epilepsy surgery is often effective in achieving seizure control, post-operative outcomes across neuropsychological, cognitive and behavioral domains remain variable and require further investigation. Method: Using advanced search terms, a systematic review of electronic databases was conducted, comprising PubMed, PsycINFO, and Scopus. Studies published from January 2010 to March 2025 were included if they involved pediatric patients (≤18 years) undergoing resective epilepsy surgery and reported pre- and/or postoperative neuropsychological, cognitive, or behavioral outcomes. Data were synthesized qualitatively due to study heterogeneity. Results: Twenty-six studies met the inclusion criteria. Global cognition was generally stable or improved. Verbal memory declined after left temporal resections, while visuospatial and attention deficits were reported after posterior resections, although laterality of resection was not consistently specified. Executive and behavioral improvements were more common in seizure-free patients. Outcomes varied by age at surgery, epilepsy duration, seizure control, and resection extent. Conclusions: While epilepsy surgery in pediatric populations can lead to neuropsychological, cognitive and behavioral improvements, outcomes remain heterogeneous, reflecting both variability in clinical presentation and the current state of evidence. The available evidence highlights the need to improve methodological quality and reporting standards. Well-designed prospective multicenter trials with adequate follow-up for long-term outcomes are essential to accurately assess outcomes. Establishing standardized core outcome measures across centers would facilitate higher quality evidence and support more informed decision-making for clinicians, patients, and families regarding surgical intervention and expected post-operative trajectories.