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Functional hemispherectomy: can preoperative imaging predict outcome?

Alexander G Weil1, Aria Fallah2, Shelly Wang3

  • 11Division of Neurosurgery, Sainte Justine Hospital, Montreal, Quebec, Canada.

Journal of Neurosurgery. Pediatrics
|May 14, 2021
PubMed
Summary
This summary is machine-generated.

Hemispherectomy is effective for pediatric epilepsy, but recurrence occurs. Contralateral MRI abnormalities predict earlier seizure recurrence, indicating a higher risk in patients with bihemispheric issues.

Keywords:
EEGMRIepilepseyhemispherectomymedically refractoryprognostic factors

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Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Epilepsy Surgery

Background:

  • Hemispherectomy is a key treatment for intractable pediatric hemispheric epilepsy.
  • Seizure recurrence affects up to 40% of patients post-hemispherectomy.
  • Causes of seizure recurrence remain incompletely understood.

Purpose of the Study:

  • Evaluate hemispherectomy efficacy at Miami Children's Hospital.
  • Determine if contralateral MRI abnormalities predict seizure recurrence.
  • Identify factors influencing seizure freedom post-surgery.

Main Methods:

  • Retrospective review of hemispherectomies (Jan 2000 - June 2014).
  • Time-to-event analysis for seizure recurrence (excluding first week and auras).
  • Analysis of preoperative variables, including contralateral MRI findings.

Main Results:

  • 72 hemispherectomies performed on 69 pediatric patients; 86% achieved Engel Class I outcome at 1 year.
  • Mean seizure recurrence time was 33.5 months.
  • Absence of contralateral MRI abnormalities correlated with longer seizure freedom (HR 4.09, p=0.009).
  • Contralateral MRI abnormalities linked to contralateral ictal seizures on EEG (p=0.002).
  • Complications occurred in 27.8% of cases, including hydrocephalus (13%).

Conclusions:

  • Contralateral MRI abnormalities indicate bihemispheric involvement.
  • Patients with contralateral MRI abnormalities face a higher risk of earlier seizure recurrence after functional hemispherectomy.