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Hemispherotomy Revised: A complication overview and a systematic review meta-analysis
Maria D Karagianni1, Alexandros G Brotis1, Anastasia Tasiou1
1Department of Neurosurgery, General University Hospital of Larissa, Mezourlo, Larissa, 41110, Greece.
Brain & Spine
|November 29, 2023
Summary
Hemispherectomy/hemispherotomy for catastrophic epilepsy has evolved significantly. Modern hemispherotomy is a safe surgical option, with mortality rates decreasing dramatically over 30 years.
Area of Science:
- Neurosurgery
- Epileptology
- Medical Technology Assessment
Background:
- Hemispherectomy/hemispherotomy is used for catastrophic epilepsy.
- Initial safety concerns regarding mortality and morbidity required re-evaluation.
- The exact role of hemispherotomy needed clarification.
Purpose of the Study:
- To systematically examine the incidence of mortality and morbidity associated with hemispherectomy/hemispherotomy.
- To evaluate the association between different hemispherotomy techniques and reported complications.
Main Methods:
- A PRISMA-compliant systematic review and meta-analysis of 37 studies.
- Searched PubMed, Scopus, and Web of Science databases until December 2022.
- Employed fixed- and random-effects models, Egger's regression test, and subgroup analysis.
Main Results:
- Overall procedure mortality was 5% (hemispherectomy 7%, hemispherotomy 3%).
- Mortality decreased from 32% to 2% over 30 years.
- Common complications included aseptic meningitis/fever (33%), hydrocephalus (16%), hematoma (8%), infections (11%), and cranial nerve deficits (11%).
Conclusions:
- The evolution from hemispherectomy to hemispherotomy, coupled with neuroanesthesia advances, significantly reduced mortality and morbidity.
- Hemispherotomy is a safe and effective surgical procedure for managing catastrophic epilepsies.
