Dysphagia after pediatric functional hemispherectomy

Buckley, Robert T.; Morgan, Tiffany; Saneto, Russell P.; Barber, Jason; Ellenbogen, Richard G.; Ojemann, Jeffrey G.

doi:10.3171/2013.10.peds13182

Cited by 11 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After exclusion of 111 studies (42 did not meet the inclusion criteria, 35 included overlapping populations, and 34 had insufficient data), a total of 25 studies met the inclusion criteria and were included in our study. 6,8,11,16,17,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] All 25 studies were retrospective consecutive case series and published between 2000 and 2019, with the cumulative studied period ranging from 1990 to 2017. Sev-enteen studies reported on LPH, 7 reported on VPH, and 1 included both techniques (Table 1).…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…There was high inhomogeneity in follow-up duration after surgery (Table 1). Nevertheless, 10 studies 6,16,27,32,37,38,40,43,44,45 included patients with follow-up < 12 months who could be identified and were excluded from the analysis of seizure outcome. The other 15 studies maintained a minimum follow-up of 12 months for all participants.…”

Section: Clinical Featuresmentioning

confidence: 99%

See 1 more Smart Citation

Lateral versus vertical hemispheric disconnection for epilepsy: a systematic review and meta-analysis

Cossu

Nichelatti

Benedictis

et al. 2022

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE Lateral periinsular hemispherotomy (LPH) and vertical parasagittal hemispherotomy (VPH) are the most popular disconnective techniques for intractable epilepsies associated with unilateral hemispheric pathologies. The authors aimed to investigate possible differences in seizure outcome and complication rates between patients who underwent LPH and VPH. METHODS A comprehensive literature search of PubMed and Embase identified English-language articles published from database inception to December 2019 that reported series (minimum 12 patients with follow-up ≥ 12 months) on either LPH or VPH. Pooled rates of seizure freedom and complications (with a particular focus on hydrocephalus) were analyzed using meta-analysis to calculate both fixed and random effects. Heterogeneity (Cochran’s Q test) and inconsistency (fraction of Q due to actual heterogeneity) were also calculated. RESULTS Twenty-five studies were included. Data from 825 patients were available for seizure outcome analysis (583 underwent LPH and 242 underwent VPH), and data from 692 patients were available for complication analysis (453 underwent LPH and 239 underwent VPH). No differences were found in the pooled rates of Engel class I seizure outcome between patients who underwent LPH (80.02% and 79.44% with fixed and random effects, respectively) and VPH (79.89% and 80.69% with fixed and random effects, respectively) (p = 0.953). No differences were observed in the pooled rates of shunted hydrocephalus between patients who underwent LPH (11.34% and 10.63% with fixed and random effects, respectively) and VPH (11.07% and 9.98% with fixed and random effects, respectively) (p = 0.898). Significant heterogeneity and moderate inconsistency were determined for hydrocephalus occurrence in patients who underwent both LPH and VPH. CONCLUSIONS LPH and VPH techniques present similar excellent seizure outcomes, with comparable and acceptable safety profiles.

show abstract

Section: Literature Search Resultsmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

Lateral versus vertical hemispheric disconnection for epilepsy: a systematic review and meta-analysis

Cossu

Nichelatti

Benedictis

et al. 2022

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Studies of children who have undergone surgical intervention for the treatment of pharmaco-resistant epilepsy have successfully characterized changes in intelligence (Vargha-Khadem et al, 1994), memory (Meekes et al, 2013), language (de Koning et al, 2009), and motor function (Buckley et al, 2014). Because there is greater plasticity in childhood than in adulthood, such investigations offer a unique opportunity to uncover the organization of complex brain-behavior relationships and their plasticity (Bourne, 2010).…”

Section: Introductionmentioning

confidence: 99%

Perceptual Function and Category-Selective Neural Organization in Children with Resections of Visual Cortex

Freud

Patterson

et al. 2019

J. Neurosci.

View full text Add to dashboard Cite

The consequences of cortical resection, a treatment for humans with pharmaco-resistant epilepsy, provide a unique opportunity to advance our understanding of the nature and extent of cortical (re)organization. Despite the importance of visual processing in daily life, the neural and perceptual sequellae of occipitotemporal resections remain largely unexplored. Using psychophysical and fMRI investigations, we compared the neural and visuoperceptual profiles of 10 children or adolescents following unilateral cortical resections and their age-and gender-matched controls. Dramatically, with the exception of two individuals, both of whom had relatively greater cortical alterations, all patients showed normal perceptual performance on tasks of intermediate-and high-level vision, including face and object recognition. Consistently, again with the exception of the same two individuals, both univariate and multivariate fMRI analyses revealed normal selectivity and representational structure of category-selective regions. Furthermore, the spatial organization of categoryselective regions obeyed the typical medial-to-lateral topographic organization albeit unilaterally in the structurally preserved hemisphere rather than bilaterally. These findings offer novel insights into the malleability of cortex in the pediatric population and suggest that, although experience may be necessary for the emergence of neural category-selectivity, this emergence is not necessarily contingent on the integrity of particular cortical structures.

show abstract

“…IPD was extracted for 145 patients, with 89 (61%) patients receiving FH and 47 (32%) patients receiving AH for initial surgical management of HME (Tables 1 and 2). 15,29,33-53 Nine (6%) patients received an unspecified hemispherectomy type. Of the 26 articles, 17 studies (65%) were deemed to have a moderate risk of bias and 9 (35%) were considered to have a severe risk of bias per ROBINS I tool (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Hemimegalencephaly: A Systematic Comparison of Functional and Anatomic Hemispherectomy for Drug-Resistant Epilepsy

Goel,

Ghadiyaram,

Krishnakumar

et al. 2023

Neurosurgery

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: Hemimegalencephaly (HME) is a rare diffuse malformation of cortical development characterized by unihemispheric hypertrophy, drug-resistant epilepsy (DRE), hemiparesis, and developmental delay. Definitive treatment for HME-related DRE is hemispheric surgery through either anatomic (AH) or functional hemispherectomy (FH). This individual patient data meta-analysis assessed seizure outcomes of AH and FH for HME with pharmacoresistant epilepsy, predictors of Engel I, and efficacy of different FH approaches. METHODS: PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were searched from inception to Jan 13th, 2023, for primary literature reporting seizure outcomes in >3 patients with HME receiving AH or FH. Demographics, neurophysiology findings, and Engel outcome at the last follow-up were extracted. Postsurgical seizure outcomes were compared through 2-tailed t-test and Fisher exact test. Univariate and multivariate Cox regression analyses were performed to identify independent predictors of Engel I outcome. RESULTS: Data from 145 patients were extracted from 26 studies, of which 89 underwent FH (22 vertical, 33 lateral), 47 underwent AH, and 9 received an unspecified hemispherectomy with a median last follow-up of 44.0 months (FH cohort) and 45.0 months (AH cohort). Cohorts were similar in preoperative characteristics and at the last follow-up; 77% (n = 66) of the FH cohort and 81% (n = 38) and of the AH cohort were Engel I. On multivariate analysis, only the presence of bilateral ictal electroencephalography abnormalities (hazard ratio = 11.5; P = .002) was significantly associated with faster time-to-seizure recurrence. A number-needed-to-treat analysis to prevent 1 additional case of posthemispherectomy hydrocephalus reveals that FH, compared with AH, was 3. There was no statistical significance for any differences in time-to-seizure recurrence between lateral and vertical FH approaches (hazard ratio = 2.59; P = .101). CONCLUSION: We show that hemispheric surgery is a highly effective treatment for HME-related DRE. Unilateral ictal electroencephalography changes and using the FH approach as initial surgical management may result in better outcomes due to significantly lower posthemispherectomy hydrocephalus probability. However, larger HME registries are needed to further delineate the predictors of seizure outcomes.

show abstract

Dysphagia after pediatric functional hemispherectomy

Cited by 11 publications

References 28 publications

Lateral versus vertical hemispheric disconnection for epilepsy: a systematic review and meta-analysis

Lateral versus vertical hemispheric disconnection for epilepsy: a systematic review and meta-analysis

Perceptual Function and Category-Selective Neural Organization in Children with Resections of Visual Cortex

Hemimegalencephaly: A Systematic Comparison of Functional and Anatomic Hemispherectomy for Drug-Resistant Epilepsy

Contact Info

Product

Resources

About