[CT and MR brain imaging following hemispherotomy]

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Neuroradiology

Background:

• Intractable epilepsy in children poses significant management challenges.
• Hemispherotomy offers a surgical option for severe, refractory epilepsy cases.

Purpose of the Study:

• To characterize typical and pathological brain changes after hemispherotomy in pediatric epilepsy patients.
• To aid in differentiating normal postoperative findings from complications on imaging.

Main Methods:

• Retrospective review of preoperative MRI and serial postoperative CT/MRI scans (1 week, 3 months, 1 year) in 52 children.
• Analysis of brain parenchyma, ventricles, subdural space, and posterior fossa.
• Patients had epilepsy due to various etiologies including dysplasia, Rasmussen's encephalitis, and Sturge-Weber disease.

Main Results:

• Hemispheric scarring was a consistent finding on CT and MRI.
• Small subdural effusions and surgical scar bleeding were common early findings.
• Chronic subdural effusions without mass effect were frequent on later scans; severe complications like hydrocephalus were rare.
• Absence of infection, extensive edema, or hemosiderosis, unlike in hemispherectomy.

Conclusions:

• Hemispherotomy is a valuable surgical treatment for intractable pediatric epilepsy.
• Understanding typical postsurgical imaging features is crucial for accurate interpretation.
• This study provides a reference for identifying expected changes and rare complications on brain imaging post-hemispherotomy.