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Postoperative development of children after hemispherotomy
Taketoshi Maehara1, Hiroyuki Shimizu, Kensuke Kawai
1Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu-shi, 183-0042 Tokyo, Japan. maehara.nsrg@tmd.ac.jp
Insights
Hemispherectomy surgery can significantly reduce seizures in children with cortical dysgenesis. Early intervention and high preoperative intellectual function correlate with better long-term developmental outcomes.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
- Neurosurgery
Background:
- Cortical dysgenesis is a congenital brain malformation associated with intractable epilepsy.
- Functional hemispherectomy (hemispherotomy) is a surgical option for severe cases.
- Understanding postoperative neurodevelopmental outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes in children with cortical dysgenesis after hemispherotomy.
- To identify factors associated with improved postoperative development.
Main Methods:
- Retrospective study of 14 children with cortical dysgenesis undergoing hemispherotomy before age 6.
- Assessment of seizure frequency and developmental quotient (DQ) preoperatively and postoperatively (24-72 months follow-up).
Main Results:
- 43% of children became seizure-free, and 43% achieved >90% seizure reduction.
- Total DQ improved from 25.5 to 31.9; intellectual DQ improved from 26.0 to 33.7.
- Motor DQ showed a slight decline from 27.4 to 22.9.
- Preoperative intellectual DQ >50 correlated with near-normal postoperative intellectual DQ.
- Children with preoperative DQ 10-50, seizure cessation, and early surgery (first 3 years) showed marked developmental progress.
Conclusions:
- High preoperative intellectual DQ and seizure cessation are associated with better postoperative intellectual development.
- Early surgical intervention may enhance developmental progress in select pediatric epilepsy cases.
- Long-term follow-up and larger cohorts are needed for definitive conclusions.
Abstract:
We studied the postoperative development of 14 children with cortical dysgenesis who underwent modified functional hemispherectomy (hemispherotomy) at the age of 6 years or younger. At follow-up of 24-72 months (median of 47 months), six (43%) were seizure-free, six achieved>90% reduction, one achieved 50-90% reduction, and one achieved 0-50% reduction in seizure frequency. At the preoperative and final postoperative examinations, mean scores of developmental quotient (DQ) were as follows: 25.5 and 31.9 in total DQ, 26.0 and 33.7 in intellectual DQ, and 27.4 and 22.9 in motor DQ. Children scoring >50 points in preoperative intellectual DQ score obtained near-normal intellectual DQ postoperatively, while, those scoring <10 DQ preoperatively remained at a low developmental level. Among children with DQ scores in the range from 10 to 50, two children who obtained seizure-free outcome and were operated upon in the first 3 years of life achieved marked developmental progress. The present study indicated that high preoperative intellectual DQ and cessation of seizures seem to be associated with better postoperative intellectual development. However, long-term observation of postoperative development and an accumulation of more cases will be needed before we can reach a firm conclusion.