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Updated: Jul 17, 2025
Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
Strabismus outcomes in pediatric patients undergoing disconnective hemispheric surgery for intractable epilepsy: a
Daiana R Pur1, Gayathri K Sivakumar2, Lulu L C D Bursztyn3
1Schulich School of Medicine and Dentistry, Western University, London, ON.
Insights
Pediatric hemispheric surgery can lead to strabismus, with postoperative rates ranging from 38% to 100%. Contralateral exodeviation is most common, but risks must be weighed against visual field expansion and diplopia concerns.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Neurosurgery
Background:
- Children undergoing hemispheric surgery for intractable seizures face risks of visual complications, notably strabismus.
- Hemispheric surgery, including hemispherectomy or hemispherotomy, is a critical intervention for pediatric epilepsy.
- Understanding post-surgical visual outcomes is crucial for comprehensive patient care.
Conclusions:
- Hemispheric surgery can result in contralateral exotropia and ipsilateral esotropia, potentially expanding visual fields.
- The benefits of strabismus surgery must be balanced against risks of visual field reduction and diplopia.
- Further high-quality research with larger, homogeneous populations and complete ophthalmologic assessments is needed to clarify risks and rates.
Background:
Children undergoing hemispheric surgery for intractable seizures are susceptible to visual complications including strabismus. This systematic review aims to investigate the rates and characteristics of strabismus development after hemispheric surgery and evaluate clinical implications for ophthalmologic care.
Methods:
A systematic search of MEDLINE, EMBASE, Cochrane, PsychINFO, and Web of Science databases was performed from database inception to May 2022. Included articles referred to strabismus outcomes in pediatric populations after hemispherectomy or hemispherotomy. Reviews and non-English-language publications were excluded. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. Demographic data and characteristics of strabismus were extracted and tabulated.
Results:
Of 41 articles identified, 10 studies consisting of 384 pediatric participants (48% females) and age at surgery between 6 months and 16 years were included. Preoperative strabismus rates ranged between 3% and 56%, whereas postoperative rates ranged between 38% and 100%. With respect to the site of hemispheric surgery, contralateral exodeviation was the most common (16%-67%; n = 7) and then ipsilateral exodeviation (16%-56%; n = 2), whereas ipsilateral esodeviation was infrequent (4%-9%; n = 3).
Conclusions:
Contralateral exotropia and ipsilateral esotropia may occur after hemispheric surgery and may have the potential to be field expanding. Concerns regarding negative social reactions should be balanced with the risk of visual field reduction and (or) diplopia by strabismus surgery. Higher-quality articles with large, homogeneous, and well-described populations (i.e., complete pre- and postoperative ophthalmologic assessments) are required to establish the risks and rates of strabismus development after hemispheric surgery.
