Abstract:Background
Techniques for achieving hemispheric disconnection in patients with epilepsy continue to evolve.
Objective
To review the outcomes of the first 50 hemispherectomy surgeries performed by a single surgeon with an emphasis on outcomes, complications, and how these results led to changes in practice.
Methods
The first 50 hemispherectomy cases performed by the lead author were identified from a prospectively maintained database. Patient demographics, surgical details, clinical outcomes, and complicati… Show more
“…A recent systematic review showed that anatomical hemispherectomy had the highest seizure freedom rate, but this was not statistically significant [79]. Reported seizure freedom rates vary significantly between 50% and 85%, with additional patients having significant seizure burden reduction [68,71,73,75,76,[79][80][81][82]. Etiology is the most important prognostic variable of seizure outcome, with acquired and progressive diseases have significantly better outcomes than developmental malformations (particularly hemimegalencephaly) [68][69][70]76,80,83].…”
Section: Discussionmentioning
confidence: 99%
“…While EEG would ideally only show epileptogenicity in one hemisphere, epileptic activity in the contralateral hemisphere is not an absolute contraindication [68,72]. Additionally, hemispherectomy has been rarely described for palliative reduction of seizure burden in bilateral cases [75].…”
Epilepsy is a common pediatric neurological condition, and approximately one-third of children with epilepsy are refractory to medical management. For these children neurosurgery may be indicated, but operative success is dependent on complete delineation of the epileptogenic zone. In this review, surgical techniques for pediatric epilepsy are considered. First, potentially-curative operations are discussed and broadly divided into resections and disconnections. Then, two palliative approaches to seizure control are reviewed. Finally, future neurosurgical approaches to epilepsy are considered.
“…A recent systematic review showed that anatomical hemispherectomy had the highest seizure freedom rate, but this was not statistically significant [79]. Reported seizure freedom rates vary significantly between 50% and 85%, with additional patients having significant seizure burden reduction [68,71,73,75,76,[79][80][81][82]. Etiology is the most important prognostic variable of seizure outcome, with acquired and progressive diseases have significantly better outcomes than developmental malformations (particularly hemimegalencephaly) [68][69][70]76,80,83].…”
Section: Discussionmentioning
confidence: 99%
“…While EEG would ideally only show epileptogenicity in one hemisphere, epileptic activity in the contralateral hemisphere is not an absolute contraindication [68,72]. Additionally, hemispherectomy has been rarely described for palliative reduction of seizure burden in bilateral cases [75].…”
Epilepsy is a common pediatric neurological condition, and approximately one-third of children with epilepsy are refractory to medical management. For these children neurosurgery may be indicated, but operative success is dependent on complete delineation of the epileptogenic zone. In this review, surgical techniques for pediatric epilepsy are considered. First, potentially-curative operations are discussed and broadly divided into resections and disconnections. Then, two palliative approaches to seizure control are reviewed. Finally, future neurosurgical approaches to epilepsy are considered.
“…The modified hemispherectomy also showed good effects on epilepsy control, resulting in Engel I in 91% and Engel II in 9% at follow-up of 7–15 years. In other reports, the rate of seizure freedom following hemispherectomy has been reported to be 52–89%, with a link in improved seizure control and cognitive motor outcomes [ 3 , 9 – 11 ]. After hemispherectomy, the abnormal waves on EEG on the healthy hemisphere might disappear completely or greatly reduce in the frequency clinically.…”
Section: Discussionmentioning
confidence: 99%
“…Since the introduction of this surgical technique as a therapeutic approach for epilepsy in 1938 [ 4 ], various modifications have been reported to ameliorate the outcome and minimize procedure-related complications [ 4 , 6 – 8 ]. The rate of seizure freedom following hemispherectomy has been reported to be 52–89%, with a link in improved seizure control and cognitive motor outcomes [ 3 , 9 – 11 ]. The postoperative mortality rate of hemispherectomy in recent decades has been shown to range from 0 to 1% [ 3 ] or 6.6% [ 12 ].…”
ObjectiveTo investigate the effect and medical imaging of modified hemispherectomy on patients with infantile hemiparesis and medically refractory epilepsy.Patients and methodsForty-three patients with infantile hemiparesis and refractory epilepsy who underwent hemispherectomy were enrolled. The treatment effect and medical imaging were analyzed.ResultsAnatomical hemispherectomy was successfully performed in all patients (100%). In all patients, the muscular tension decreased and the contracted limbs relaxed. In the pathological examination of the resected brain tissue, secondary cicatricial gyri with concomitant cortical dysplasia was present in 36 cases and polycerebellar gyrus malformation and porencephalia in the other 7 cases. Followed up for 7–15 years (mean 11.3), all patients were alive without a long-term sequela. Epilepsy was satisfactorily controlled, with complete seizure relief in 39 cases (91%) classified as Engel I and basic control in the other 4 (9%) defined as Engel II. The posthemispherectomy medical imaging demonstrated that the intracranial space on the operative side shrank, and the healthy cerebral hemisphere shifted markedly toward the hemispherectomy side, with expanded lateral ventricle on the healthy side and thickened skull and enlarged frontal sinus on the operative side. After 4–5 years, the intracranial space on the operative side disappeared in 75% of the patients, demonstrating enlarged cerebral peduncle on the healthy side.ConclusionFurther modified hemispherectomy in patients with infantile hemiparesis and medically refractory epilepsy demonstrated markedly ameliorated effects on epilepsy control and the prevention of superficial cerebral hemosiderosis in the long-term follow-up.
“…Extensive clinical experience has established the effectiveness of PIH [10,11], and the efficacy and safety of vertical hemispherotomy have recently been investigated [4,6,12]. In a recent series of 40 cases of vertical hemispherotomy [12], a permanent cerebrospinal fluid shunt was necessary in only 2.5% of cases, compared to the 5-26% incidence in previous series of PIH [10,11]. Blood replacement was necessary in only 2 infants (5.0%) [12].…”
Purpose: Hemispheric epileptogenic lesions such as hemimegalencephaly often manifest as intractable epilepsy in early infancy. Hemispherotomy is the treatment of choice for controlling intractable hemispheric epilepsy. Less invasive procedures are desirable for surgery on infants with low body weight. This study compared our experience with interhemispheric vertical hemispherotomy (IVH) and peri-insular lateral hemispherotomy (PIH). Methods: Thirteen consecutive patients underwent hemispherotomy for treatment of intractable epilepsy in our institution between 2001 and 2012. The etiology of epilepsy included hemimegalencephaly in 7 patients and cortical dysplasia in 3. PIH was performed on the first 5 patients and IVH on the last 8 patients. In the latter procedure, complete section of the corpus callosum was first performed via the interhemispheric approach. After removing part of the cingulate gyrus, section of the descending fibers was performed anterolaterally to the thalamus. Clinical characteristics, duration of operation and amount of blood transfusion were compared between the PIH and IVH groups. Results: There was no difference in age at surgery, body weight and age of epilepsy onset between the two groups. No surgery-related death was observed. No patients required shunt operation. One patient who underwent IVH required reoperation for incomplete disconnection. The amount of intraoperative blood transfusion was smaller and the total duration of operation was shorter in the IVH group than in the PIH group. Conclusion: The interhemispheric approach minimizes cortical resection and may be less invasive than PIH. IVH is advantageous for treating infants with low body weight.
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