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Etiology and Age Modifies Subjective Visual Function After Cerebral Hemispherectomy.

Monica F Chen1, Elana Meer1, Federico G Velez1,2

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Cerebral hemispherectomy for epilepsy often leads to vision and posture issues like torticollis and strabismus. Early discussion and ophthalmologic assessment are recommended for affected children.

Keywords:
epilepsyneuroophthalmologyneurosurgeryophthalmologyseizuressurgery

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Area of Science:

  • Neurology
  • Ophthalmology
  • Pediatric Surgery

Background:

  • Cerebral hemispherectomy is a treatment for drug-resistant epilepsy.
  • Visual outcomes post-hemispherectomy are understudied, beyond known homonymous hemianopia.
  • This study investigates functional vision, oculomotor, and postural changes after hemispherectomy.

Purpose of the Study:

  • To determine and characterize parent-reported functional visual changes.
  • To assess oculomotor changes following hemispherectomy.
  • To evaluate postural changes in patients post-hemispherectomy.

Main Methods:

  • An online survey was distributed to parents of children who underwent hemispherectomy.
  • Families were recruited via the Brain Recovery Project: Childhood Epilepsy Surgery Foundation.
  • Parent-reported data included peripheral field defects, ocular misalignment, and anomalous head posture.

Main Results:

  • 93% of parents reported peripheral vision difficulties.
  • Torticollis affected 62% and strabismus 49% of patients post-surgery.
  • Younger age at seizure onset/surgery and specific etiologies increased risk for torticollis and strabismus.

Conclusions:

  • Torticollis and strabismus are common sequelae of hemispherectomy.
  • Etiology and age at surgery influence the development of these conditions.
  • Preoperative counseling and postoperative ophthalmologic evaluations are advised.