Surgery for Intractable Epilepsy Due to Unilateral Brain Disease: A Retrospective Study Comparing Hemispherectomy Techniques

Pinto, Anna; Lohani, Subash; Bergin, Ann M.; Bourgeois, Blaise F. D.; Black, Peter McL.; Prabhu, Sanjay P.; Madsen, Joseph R.; Takeoka, Masanori; Poduri, Annapurna

doi:10.1016/j.pediatrneurol.2014.05.018

Cited by 34 publications

(35 citation statements)

References 23 publications

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“…9 Pinto et al, in 2014, looked separately for two different groups of patients with discrete etiologies who underwent hemispherotomy surgery: one with hemispheric congenital lesions and another with hemispheric acquired lesions. 16 They noticed that 2 among 22 patients with cortical malformations and none among 14 patients with acquired lesions needed a redo disconnection procedure after an initial functional hemispherectomy, underlining the complexity and difficulty of managing the first group.…”

Section: Reoperation Series and Outcomesmentioning

confidence: 99%

“…Congenital malformations are usually the most difficult etiology to achieve complete disconnection. 2,16,18 Hemimegalencephaly is the most challenging one, due to significant anatomical distortion and a greater propensity to bleeding. A histopathological diagnosis of malformation of cortical development tends to yield worse prognoses and is a risk factor for recurrence.…”

Section: Etiologymentioning

confidence: 99%

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Risk factors and results of hemispherotomy reoperations in children

Santos

Teixeira²,

Ioriatti³

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe goal of this study was to perform an analysis of a single-center experience with hemispherotomy reoperations for refractory hemispheric pediatric epilepsy due to persistence of seizures after initial surgery. The authors also identify possible anatomical and neurophysiological reasons for hemispherotomy failure, as well as risk factors and surgical options for this subgroup of patients.METHODSA review was performed of the medical records in 18 consecutive cases in which candidates for redo hemispherotomy were treated between 2003 and 2018 at the authors’ epilepsy surgery center. Fourteen patients underwent reoperation due to seizure recurrence and were studied herein, whereas in 3 the initial surgical procedure was stopped because of uncontrollable bleeding, and the remaining patient refused to undergo a reoperation in spite of seizure recurrence and went on to have a vagus nerve stimulation device placed.RESULTSAmong the 14 patients whose seizures recurred and in whom reoperations were done, the etiology of epilepsy consisted of 7 cases with malformations of cortical development (50%), 5 cases of Rasmussen encephalitis (35.8%), 1 case of porencephaly (7.1%), and 1 case of Sturge-Weber syndrome (7.1%). Eleven patients had radiological evidence of incomplete disconnection. After reoperation, 6 patients were Engel class IA, 1 was Engel II, 5 were Engel III, and 2 were Engel IV, within a mean follow-up of 48.4 months.CONCLUSIONSPatients with malformations of cortical development have a higher risk of seizure recurrence, and these malformations comprised the main etiology in the reoperation series. Failure of an initial hemispherotomy usually occurs due to incomplete disconnection and needs to be extensively assessed. Outcomes of reoperation are most often favorable, with acceptable complication rates.

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Section: Reoperation Series and Outcomesmentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Risk factors and results of hemispherotomy reoperations in children

Santos

Teixeira²,

Ioriatti³

et al. 2020

Neurosurgical Focus

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“…Major surgical operation methods include anatomical hemispherectomy, functional hemispherectomy, and hemidecortication, etc . [ 36 ]. Through the study of 83 children with drug-resistant epilepsy, Delalande O et al .…”

Section: Surgical Treatment Of Drug-resistant Epilepsymentioning

confidence: 99%

Drug-Resistant Epilepsy and Surgery

Sheng

Shui

Qin

et al. 2017

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Background:Epilepsy is a chronic brain disease that is caused by various factors and characterized by recurrent, episodic and temporary central nervous system dysfunction which results due to excessive discharge of brain neurons. In the past decades, despite the continuous development of antiepileptic drugs, there are still many patients with epilepsy progressing to drug-resistant epilepsy. Currently, surgical treatment is one of important way to cure drug-resistant epilepsy.Methods:Data were collected from Web of Science, Medline, Pubmed, through searching of these keywords: “surgery” and “drug-resistant epilepsy”.Results:An increasing number of studies have shown that surgery plays an important role in the treatment of drug-resistant epilepsy. Moreover, the comprehensive treatment mainly based on surgery can achieve the remission and even cure of drug-resistant epilepsy.Conclusion:In this review, we discuss the pathogenesis of drug-resistant epilepsy and the comprehensive treatment mainly based on surgery; this review may provide a reference for the clinical treatment of drug-resistant epilepsy.

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“…Today, several surgical techniques are used to remove or disconnect a cerebral hemisphere, including anatomical hemispherectomy, functional hemispherectomy, and hemidecortication (80). Each approach has its distinct risks and benefits, with higher rates of complications in complete anatomic hemispherectomy but lower rates of repeat surgery (81).…”

Section: Hemispherectomymentioning

confidence: 99%

Surgical strategies for pediatric epilepsy

Guan

Karsy

Ducis³

et al. 2016

Transl. Pediatr.

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Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20-30% of children with recurrent seizures have drug-resistant epilepsy (DRE).For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal-seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each.

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Surgery for Intractable Epilepsy Due to Unilateral Brain Disease: A Retrospective Study Comparing Hemispherectomy Techniques

Cited by 34 publications

References 23 publications

Risk factors and results of hemispherotomy reoperations in children

Risk factors and results of hemispherotomy reoperations in children

Drug-Resistant Epilepsy and Surgery

Surgical strategies for pediatric epilepsy

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