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Peri-Insular Hemispherotomy: A Systematic Review and Institutional Experience
Charles F Yates1,2,3, Stephen Malone4,5, Kate Riney3,4
1Department of Neurosurgery, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Pediatric Neurosurgery
|January 24, 2023
Summary
Peri-insular hemispherotomy (PIH) offers excellent seizure control for intractable epilepsy, with over 80% achieving Engel class 1 outcomes. Careful assessment is needed for very young patients due to higher hydrocephalus risk.
Area of Science:
- Neurosurgery
- Epilepsy Surgery
- Pediatric Neurology
Background:
- Peri-insular hemispherotomy (PIH) is a specific surgical technique for intractable epilepsy.
- Existing research often groups PIH with other hemispherotomy methods, obscuring its unique outcomes.
- This study focuses on PIH's patient selection, outcomes, and complications.
Approach:
- A systematic literature review adhering to PRISMA guidelines was performed.
- Searches included PubMed and Embase databases.
- A local case series from Queensland Children's Hospital (2014-2020) was incorporated.
Key Points:
- The systematic review analyzed 393 patients from 13 studies, showing 82.4% Engel class 1 outcomes.
- Post-operative hydrocephalus occurred in 8.6% of patients, predominantly in younger cohorts.
- Patients with developmental pathology had lower Engel 1 outcomes (69.1%) compared to acquired pathology (83.7%).
- The local series of 13 patients reported 84.6% Engel 1 outcomes, with 15.4% developing hydrocephalus and 76.9% experiencing worsened neurological deficit.
Conclusions:
- PIH achieves Engel 1 outcomes in over 80% of selected patients, surpassing combined hemispherotomy analyses.
- The technique is effective for both developmental and acquired pathologies.
- While beneficial for very young patients, PIH carries a higher risk of hydrocephalus, necessitating careful risk-benefit evaluation.
