Extensive lesions of the posterior quadrant are a relevant cause of pediatric drug-resistant epileptic encephalopathy, which comprises a wide range of causes, including multifocal cortical dysplasia (i.e. hemimegalencephaly), tuberous sclerosis, periventricular nodular heterotopia, Sturge-Weber syndrome (SWS), and various forms of encephalomalacia resulting either from a perinatal vascular event (e.g., porencephalic cyst, ulegyria), trauma, or prior surgery (e.g., extensive brain tumor, arteriovenous malformation) [1].

Early epilepsy surgery is the best treatment, but surgical approaches to such cases have traditionally included hemispherotomy and multilobar resections, carrying a significant surgical risk in pediatric patients [2], [3], [4].

Despite temporo-parieto-occipital (TPO) disconnection being the preferable technique for focal epilepsy of the posterior quadrant due to the preservation of motor function, very few epilepsy surgery centers have experience with the procedure, and studies reporting long-term longitudinal outcomes are still limited [5], [6], [7], [8].