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Updated: Sep 2, 2025
Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
Functional hemispherotomy for epilepsy in the very young
Joshua Pepper1, William B Lo1, Shakti Agrawal2
11Department of Neurosurgery.
Insights
Functional hemispherotomy effectively controls seizures in young children with epilepsy, with most achieving excellent outcomes. While developmental progress continues, it remains delayed post-surgery, especially for infants under 6 kg.
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.
Objective:
Epilepsy is one of the most common neurological disorders in children. Among very young children, one-third are resistant to medical treatment, and lack of effective treatment may result in adverse outcomes. Although functional hemispherotomy is an established treatment for epilepsy, its outcome in the very young child has not been widely reported. In this study the authors investigated seizure and developmental results after hemispherotomy in children younger than 3 years.
Methods:
The authors reviewed a prospective database of all children younger than 3 years with medically intractable epilepsy who underwent functional hemispherotomy at the authors' institution during the period between 2012 and 2020. Demographic data, epilepsy history, underlying etiology, operative and transfusion details, and seizure and developmental outcomes were analyzed.
Results:
Twelve patients were included in this study. The mean age (± SD) at seizure onset was 3 ± 2.6 months and at surgery was 1.3 ± 0.77 years, with a mean follow-up of 4 years. Diagnoses included hemimegalencephaly (n = 5), hemidysplasia (n = 2), hypoxic/hemorrhagic (n = 2), traumatic (n = 1), Sturge-Weber syndrome (n = 1), and mild hemispheric structural abnormality with EEG/PET correlates (n = 1). Eleven patients achieved an Engel class I outcome, and 1 patient achieved Engel class IV at last follow-up. No deaths, infections, cerebrovascular events, or unexpected long-term neurological deficits were recorded. All children progressed neurodevelopmentally following surgery, but their developmental levels remained behind their chronological age, with an overall mean composite Vineland Adaptive Behavior Scale score of 58 (normal: 86-114, low: < 70). One patient required insertion of a subdural peritoneal shunt, 1 patient required dural repair for a CSF fluid leak, and 1 patient required aspiration of a pseudomeningocele. In 2 patients, both of whom weighed less than 5.7 kg, the first operation was incomplete due to blood loss.
Conclusions:
Hemispherotomy in children younger than 3 years offers excellent seizure control and an acceptable risk-to-benefit ratio in well-selected patients. Families of children weighing less than 6 kg should be counseled regarding the possibility of staged surgery. Postoperatively, children continue to make appropriate, despite delayed, developmental progress.
