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Surgical indication in children with congenital hemiparesis
C Di Rocco1, M Caldarelli, F Guzzetta
1Institute of Neurosurgery, Catholic University Medical School, Rome, Italy.
Insights
Surgery for intractable epilepsy caused by middle cerebral artery occlusion improved motor function and reduced seizures in eight pediatric patients. This intervention offers significant benefits for children with this rare neurological condition.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Neurology
Background:
- Perinatal middle cerebral artery (MCA) occlusion can lead to significant neurological deficits in children.
- Affected children often present with intractable epilepsy, hemiparesis, and psychomotor retardation.
- Unilateral lateral cerebral ventricle enlargement, cortical atrophy, and subcortical cavity formation are characteristic findings.
Purpose of the Study:
- To evaluate the efficacy of surgical cortical resection in children with intractable epilepsy secondary to perinatal MCA occlusion.
- To assess the impact of surgery on motor function, intellectual performance, and seizure control.
Main Methods:
- Surgical treatment involved the removal of the atrophic cerebral cortex in nine children.
- Patients were monitored for post-operative outcomes, including neurological function, seizure frequency, and intellectual performance.
Main Results:
- Eight out of nine children showed significant clinical improvement post-surgery.
- Benefits included decreased limb hypertonia, improved dexterity and gait, and enhanced intellectual performance.
- Five patients became seizure-free, and three experienced a substantial reduction in seizure frequency.
Conclusions:
- Surgical resection of atrophic cerebral cortex is a beneficial treatment for intractable epilepsy in children with perinatal MCA occlusion.
- The procedure can lead to substantial improvements in motor function, cognitive abilities, and seizure control.
- This surgical approach offers a promising therapeutic option for this specific pediatric neurological condition.
Abstract:
Nine children with perinatal occlusion of the middle cerebral artery, resulting in unilateral enlargement of one lateral cerebral ventricle associated with cortical atrophy and subcortical cavity formation, were operated on because of intractable epilepsy. All subjects exhibited mild to severe hemiparesis, localized in the right side of the body in six instances and in the left side in the three cases. All but one patient presented with some degree of psychomotor retardation. The surgical treatment consisted of the removal of the atrophic cerebral cortex. One child died after surgery because of disseminated intravascular coagulation. All the remaining eight children benefited from the operation, with a decrease in the hypertonia of the affected limbs and an improvement in dexterity and gait as well as in intellectual performance. Five patients could be considered seizure-free following the surgical treatment, and the remaining three experienced a significant reduction in the frequency of the seizures.