Functional hemispherotomy for epilepsy in the very young.

Area of Science:

• Pediatric Neurology
• Neurosurgery

Background:

• Epilepsy is a common childhood neurological disorder, with one-third of very young children exhibiting drug-resistant epilepsy.
• Effective treatment is crucial to prevent adverse outcomes in pediatric epilepsy.
• Functional hemispherotomy is an established epilepsy treatment, but its outcomes in children under three years are less reported.

Purpose of the Study:

• To investigate seizure and developmental outcomes following functional hemispherotomy in children younger than three years.
• To evaluate the efficacy and safety of hemispherotomy in very young children with intractable epilepsy.

Main Methods:

• A prospective database review of children under three years with medically intractable epilepsy who underwent functional hemispherotomy between 2012 and 2020.
• Analysis of demographic data, epilepsy history, etiology, surgical details, and seizure and developmental outcomes.

Main Results:

• Twelve patients (mean age at surgery 1.3 years) were included, with diagnoses including hemimegalencephaly, hemidysplasia, and hypoxic/hemorrhagic insults.
• Eleven patients achieved Engel class I seizure control; all showed neurodevelopmental progress, albeit delayed.
• No deaths or major complications were recorded; minor complications included CSF leak and pseudomeningocele aspiration. Two low-weight patients experienced intraoperative blood loss.

Conclusions:

• Hemispherotomy provides excellent seizure control with an acceptable risk-benefit ratio in well-selected pediatric epilepsy patients under three years.
• Families of infants weighing less than 6 kg should be informed about potential staged surgical procedures.
• Postoperative developmental progress is appropriate but delayed, necessitating continued monitoring and support.