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Updated: Apr 11, 2026
Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
An observational study on outcome of hemispherotomy in children with refractory epilepsy
Manas Panigrahi1, Shyam Sundar Krishnan1, Sudhindra Vooturi2
1Department of Neurosurgery, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 03 Telangana, India.
Insights
Hemispherotomy effectively treats refractory hemispheric epilepsy in children, achieving seizure freedom in 90.5% of cases. This surgical intervention also significantly improves quality of life in epilepsy (QOLIE) scores within two years post-operation.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Refractory hemispheric epilepsy poses significant challenges in pediatric patients.
- Hemispherotomy is a surgical option for severe, intractable epilepsy affecting one hemisphere.
Purpose of the Study:
- To evaluate the clinical characteristics and outcomes of hemispherotomy in children with refractory hemispheric epilepsy.
- To compare the efficacy of different hemispherotomy techniques.
Main Methods:
- Retrospective analysis of 21 children (≤12 years) with refractory hemispheric epilepsy undergoing hemispherotomy.
- Follow-up of at least two years post-surgery.
- Comparison between Delalande's vertical para-sagittal hemispherotomy (VPH) and lateral peri-insular functional hemispherotomy.
Main Results:
- Gliosis due to childhood infarct (62.0%) and Rasmussen's encephalitis (28.5%) were the most common etiologies.
- 90.5% of patients achieved seizure freedom at the last follow-up.
- No significant difference in seizure freedom or acute post-operative seizures between VPH and lateral peri-insular functional hemispherotomy groups.
Conclusions:
- Hemispherotomy is a highly effective treatment for medically refractory hemispheric epilepsy in children.
- The procedure leads to significant seizure reduction and improved quality of life.
- Gliosis due to infarct is a primary indication for hemispherotomy in this pediatric population.
Introduction:
The current study aimed to evaluate the clinical characteristics and outcome of hemispherotomy in children with refractory hemispherical epilepsy.
Methods:
Retrospective analysis of data in twenty one children aged ≤12 years who underwent hemispherotomy and had at least two years post surgery follow-up was performed. Sixteen children underwent Delalande's vertical para-sagittal hemispherotomy (VPH), while lateral peri-insular functional hemispherotomy was performed in the rest.
Results & Discussion:
The average age of onset for epilepsy in the study population was 2.9 ± 2.4 years; the average duration of epilepsy was 4.0 ± 2.9 years. The mean age at surgery of the study population was 6.8 ± 2.8 years. Six (28.5%) children were girls. Gliosis due to presumed childhood infarct was most common etiology, observed in 13 (62.0%) of the children, followed by Rasmussen's encephalitis in six (28.5%). There was no significant difference between the surgery groups for the reported acute post operative seizures (APOS) (20.0% vs. 25.0%; p = 1.000). At last follow up 90.5% patients were seizure free; there was no difference between the groups for seizure freedom (60.0% vs. 87.5%; p = 0.228). When analyzed for outcome between the etiologies, seizure freedom was similar for gliosis due to infarct (76.9%), Rassmussens encephalitis (83.3%) and malformations of cortical development (MCD) (100.0%). Moreover, improved quality of life in epilepsy (QOLIE) scores was observed in 80.0% of the lateral peri-insular functional hemispherotomy group and 87.5% children in VPH group at the last follow-up.
Conclusion:
Gliosis due to presumed childhood infarct was the leading cause of medically refractory epilepsy caused by hemispheric lesions in the current study. Encouragingly, hemispherotomy offers seizure freedom (in 90.5% patients) and improvement in QOLIE scores at two years follow up.
