Hemispherotomy for pediatric epilepsy: a systematic review and critical analysis

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Epileptology

Background:

• Drug-resistant epilepsy in children often requires surgical intervention.
• Functional disconnection surgeries, like hemispherotomy, are used for lateralized epilepsy.
• Understanding patient selection and outcomes is crucial for surgical success.

Purpose of the Study:

• To systematically review the literature on hemispherotomy for pediatric drug-resistant epilepsy.
• To analyze patient selection criteria, surgical approaches, and outcomes.
• To synthesize evidence on seizure control and functional status post-hemispherotomy.

Main Methods:

• Systematic review of English literature up to February 2019, following PRISMA guidelines.
• Classification of studies by evidence level (III and IV).
• Critical analysis of seizure outcomes, functional outcomes, surgical techniques, complications, and patient selection.

Main Results:

• 173 papers reviewed; 37 met inclusion criteria.
• Vertical and lateral hemispherotomy showed comparable seizure freedom and functional outcomes.
• Parasagittal and interhemispheric approaches may offer reduced operative time and blood loss.
• Etiology, bilateral MRI findings, and nonlateralizing EEG did not predict poorer outcomes.

Conclusions:

• Hemispherotomy provides durable and reproducible benefits for epilepsy severity and functional status in selected pediatric patients.
• Both vertical and lateral surgical approaches are effective.
• Appropriate patient selection is key to achieving positive outcomes.