Hemispherotomy and functional hemispherectomy: indications and outcome

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Epileptology

Background:

• Refractory hemispheric epilepsy in children presents significant challenges.
• Peri-insular hemispherotomy offers functional isolation of epileptogenic zones.
• Limited data exists on outcomes across diverse etiologies in pediatric cases.

Purpose of the Study:

• To evaluate the efficacy and outcomes of peri-insular hemispherotomy in pediatric patients with refractory hemispheric epilepsy.
• To analyze seizure control and quality of life improvements post-surgery.
• To explore the influence of underlying etiology on surgical outcomes.

Main Methods:

• A consecutive series of 13 pediatric patients with refractory hemispheric epilepsy underwent peri-insular hemispherotomy.
• Preoperative assessment included electro-clinical evaluation and MRI.
• Patients were followed for a mean of 4.5 years, with outcomes classified using the Engel scale.

Main Results:

• Overall, 8 out of 13 patients achieved seizure freedom (Engel Class I).
• Etiologies like Rasmussen encephalitis and perinatal strokes showed the best outcomes, with 75% seizure freedom.
• Patients with hemimegalencephaly had poorer outcomes, with two requiring reoperation without improvement.

Conclusions:

• Peri-insular hemispherotomy is a successful treatment for medically intractable hemispheric epilepsy in children.
• The procedure yields significant improvements in seizure control and quality of life.
• Etiology plays a crucial role in determining surgical success, with specific conditions benefiting more.