Comparison of the real‐world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug‐resistant epilepsy: A post hoc analysis of the HOPS study

Abstract

Objective:This study was undertaken to determine whether the vertical parasagittal approach or the lateral peri-insular/peri-Sylvian approach to hemispheric surgery is the superior technique in achieving long-term seizure freedom.Methods:We conducted a post hoc subgroup analysis of the HOPS (Hemispheric Surgery Outcome Prediction Scale) study, an international, multicenter, retrospective cohort study that identified predictors of seizure freedom through logistic regression modeling. Only patients undergoing vertical parasagittal, lateral peri-insular/peri-Sylvian, or lateral trans-Sylvian hemispherotomy were included in this post hoc analysis. Differences in seizure freedom rates were assessed using a time-to-event method and calculated using the Kaplan-Meier survival method.

Clinical adult outcome 11–30 years after pediatric epilepsy surgery: Complications and other surgical adverse events, seizure control, and cure of epilepsy

“…The rate of favorable long‐term seizure outcomes in our study was 73% (66% seizure free plus 7% of patients with auras only). Other comparable long‐term adult clinical outcome studies reported (almost) equal, 10,12,13,17 slightly higher, 11,15 or lower 16 seizure‐free outcome rates, clearly depending on included etiologies. Compared to our own previous short‐ and intermediate‐term pediatric epilepsy surgery outcome studies, 8,35,36 we descriptively obtained a slightly lower favorable seizure outcome rate in the present long‐term study.…”

“…9 In the present study, we evaluated the comprehensive patient/parent-reported clinical outcome in now adult patients who underwent epilepsy surgery as children, with a follow-up interval of at least 10 years. We are aware of five studies that reported adult clinical outcomes more than 10 years after pediatric epilepsy surgery [10][11][12][13][14] ; however, three of these studies included patients who were not yet adults at the follow-up. [10][11][12] Two further studies had a mean or median follow-up interval of about 10 years 15,16 ; and one study aimed at a follow-up interval of 15 or more years but the interval finally ranged from 4 to 27 years (mean 19 years).…”

“…Five of the seven long-term studies did not report surgical adverse events or complications. [12][13][14]16,17 In the present study we re-evaluated pediatric epilepsy surgery with regard to safety and efficacy.…”

Medical treatment of Rasmussen's Encephalitis: A systematic review

“…Recovery of independent walking is expected although fine motor movement in the hand is not. Among surgical procedures of hemispheric disconnection, hemispherotomy techniques exhibits the best results in term of seizure outcome [29,30]. The decision of surgery is still however difficult in slow progressive form with limited neurological deficit and /or older children or adult onset in addition when dominant hemisphere is involved.…”

Vertical hemispherotomy for drug‐resistant epilepsy: Toward confirmation of the HOPS study

“…To the Editors: We read with great interest the study reported by Aria Fallah et al concerning the comparison of the real-world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drugresistant epilepsy through a post hoc analysis of the HOPS study. 1 We would first like to congratulate the authors for this remarkable study carried out using data from the HOPS study, 2 a model of a constructive international collaboration that is particularly useful in the evaluation of techniques with rare and specific indications such as functional hemispherotomy. Through a methodologically rigorous analysis, the authors provide a strong argument in favor of better long-term effectiveness of the vertical hemispherotomy (seizure freedom = 85.5% at 10-year follow-up) compared to the peri-insular technique (seizure freedom = 57.2% at 10-year follow-up).…”