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Pediatric functional hemispherectomy: outcome in 92 patients
J Schramm1, S Kuczaty, R Sassen
1Department of Neurosurgery, Bonn University Medical Center, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
Acta Neurochirurgica
|September 4, 2012
Summary
Hemispherotomy surgery is highly effective for treating pediatric epilepsy, with 85% of patients becoming seizure-free. The transsylvian keyhole technique shows excellent outcomes, demonstrating the safety and efficacy of these epilepsy surgery procedures.
Area of Science:
- Neurosurgery
- Pediatric Epilepsy
- Epilepsy Surgery Outcomes
Background:
- Epilepsy surgery, particularly hemispherectomy and hemispherotomy, has seen a resurgence due to advanced presurgical evaluation techniques.
- This study focuses on outcomes of a newer transsylvian keyhole hemispherotomy technique in pediatric patients.
Purpose of the Study:
- To evaluate the effectiveness and safety of the transsylvian keyhole hemispherotomy technique in pediatric patients with drug-resistant epilepsy.
- To analyze factors influencing seizure control, including etiology and surgical approach.
Main Methods:
- Ninety-six pediatric patients (4 months to 18 years) underwent hemispherotomy between 1990 and 2009, with 92 available for follow-up.
- Data collected included diagnosis, surgical technique (transsylvian keyhole hemispherotomy), seizure outcomes (ILAE class), shunt rates, and mortality.
- Patients were analyzed based on etiology, age at seizure onset, and duration of epilepsy.
Main Results:
- 85% of all patients achieved seizure freedom (ILAE class 1) at last available outcome.
- The transsylvian keyhole technique, used in 71 patients, resulted in 89% seizure freedom.
- Etiologies like Sturge-Weber syndrome and porencephaly showed excellent seizure control, while hemimegalencephaly (HME) had poorer outcomes. Shunt rates were low (3% for keyhole technique).
Conclusions:
- Hemispherotomies and functional hemispherectomies are highly effective and safe for extensive unihemispheric pathologies in pediatric epilepsy.
- Surgical technique and underlying etiology significantly impact seizure outcome in pediatric epilepsy surgery.
