Peri-insular hemispherotomy in children: a single institution experience

The objective of this paper is to evaluate our experience in performing peri-insular hemispherotomy in refractory epileptic children. First, we address the history of hemispheric surgeries for epilepsy and then we compare our results to the medical literature in term of seizure control and complications. Between 1993 and 2007, 14 children who suffered from refractory hemispheric epilepsy underwent a peri-insular hemispherotomy. All children's charts were reviewed in a retrospective manner. Age at onset of epilepsy, imaging studies, cause of refractory epilepsy, electroencephalography findings, type of epileptic seizure, number of antiepileptic drugs (AED), preoperative neuropsychological evaluation and surgical outcome with regard to the children's seizure activity were analyzed. Nine boys and 5 girls were enrolled in this study. The mean age at onset of epilepsy was 16 months (range birth-5 years). All the children presented complex partiel seizures. Seizure frequency varied from 5 to 100 a day. The average delay prior to the hemispherotomy was 83 months (range 12-226 months). Mean age at the time of the surgery was 8.4 years (range 1.7-18 years). We performed 9 peri-insular hemispherotomies on the right side and 5 on the left. There were no reported surgical complications in this series. 10 children are seizure free (72%). Peri-insular hemispherotomy must be considered as a safe and very efficient therapeutic approach for children suffering from hemispheric refractory epilepsy. Peri-insular hemispherotomies are procedures where pathology and surgical technique interact narrowly. Acquired pathologies had better results than developmental ones.