Hippocampal resection during hemispherotomy: is it needed?

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Epileptology

Background:

• Hemispherotomy is a key surgical option for intractable pediatric hemispheric epilepsy.
• Surgical techniques have evolved from complete resection to disconnective hemispherotomy (DH).
• Anterior temporal lobectomy (ATL) with hippocampal resection is frequently combined with DH.

Purpose of the Study:

• To evaluate the impact of hippocampal resection versus disconnection within DH procedures.
• To determine if concomitant hippocampal resection offers additional seizure control benefits in pediatric DH.

Main Methods:

• Retrospective analysis of clinical data from 86 pediatric patients undergoing DH (2001-2022).
• Comparison of epilepsy status and surgical outcomes between patients with hippocampal resection (via ATL) and hippocampal disconnection.
• Analysis included various DH techniques and patient demographics.

Main Results:

• No significant difference in Engel outcome scores between the hippocampal resection (n=43) and disconnection (n=43) groups (p=0.53).
• Common etiologies included stroke, Rasmussen's encephalitis, cortical dysplasia, and hemimegaloencephaly.
• Mean follow-up was 41.5 months, with a mean age at surgery of 7 years.

Conclusions:

• Disconnective hemispherotomy is highly effective for pediatric intractable hemispheric epilepsy.
• Hippocampal resection does not appear to provide additional therapeutic benefit in DH.
• These findings support considering DH without routine hippocampal resection.