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Hemispherectomy in infants: an institutional experience with 21 patients
Dominic Nistal1, Robert Buckley1, Scott Boop1
11Department of Neurological Surgery, University of Washington & Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington; and.
Journal of Neurosurgery. Pediatrics
|January 22, 2026
Summary
Functional hemispherectomy is a safe and effective treatment for drug-resistant epilepsy (DRE) in infants, achieving excellent seizure control. This procedure offers significant benefits for infants with hemispheric-onset epilepsies, improving their quality of life.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Surgical Neurology
Background:
- Drug-resistant epilepsy (DRE) in infants often stems from structural abnormalities, leading to difficult-to-control seizures and impaired neurodevelopment.
- Hemispherectomy is a known treatment for refractory epilepsy but has limited use in infants due to safety concerns.
Purpose of the Study:
- To review institutional experience with hemispherectomy in infants.
- To demonstrate the safety and efficacy of functional hemispherectomy in this young population.
Main Methods:
- Retrospective chart review of infants (<1 year) undergoing modified functional hemispherectomy for DRE.
- Primary outcome: favorable seizure outcome (Engel class I-II) at 1-year follow-up.
- Secondary outcomes: complications, hydrocephalus, nutritional support, medication burden.
Main Results:
- Twenty-one infants (mean age 6.2 months) underwent surgery; hemimegalencephaly was the most common cause (52%).
- No serious adverse events; complications included venous sinus thrombosis (5%), hydrocephalus (14%), and electrolyte derangements (5%).
- 95% achieved favorable seizure outcome (Engel class I-II), with 90% achieving Engel class I.
Conclusions:
- Functional hemispherectomy is safe and well-tolerated in infants with hemispheric-onset epilepsies.
- The procedure offers excellent seizure control outcomes.
- Minimizing blood loss and multidisciplinary care are crucial for success; further studies on long-term outcomes are needed.
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