Intractable epilepsy after a functional hemispherectomy: important lessons from an unusual case. Case report

Area of Science:

• Neurosurgery
• Epileptology
• Pediatric Neurology

Background:

• Functional hemispherectomy is a treatment for catastrophic epilepsy.
• Residual seizures occur in about 20% of patients post-surgery.

Observation:

• An 8-year-old boy with intractable epilepsy underwent hemispherectomy.
• New seizure patterns emerged, localized to residual frontobasal tissue.

Findings:

• Complete disconnection was achieved, except for residual frontal basal tissue.
• Resection of this dysplastic tissue resulted in 21 months of seizure freedom.

Implications:

• Residual frontal basal tissue can be a source of refractory seizures post-hemispherectomy.
• Thorough assessment is crucial for patients with persistent seizures after surgery.