Authors :
Presenting Author: Hope Reecher, BS – Medical College of Wisconsin
Katrina Pfaffenbach, BA BS – Medical College of Wisconsin
Jennifer Koop, PhD – Medical College of Wisconsin
Shane Huang, MS – Medical College of Wisconsin
Irene Kim, MD – Medical College of Wisconsin
Sean Lew, MD – Children's Wisconsin, Medical College of Wisconsin
Rationale:
Corpus callosotomy (CC) and hemispherotomy are surgical options for pediatric medically resistant epilepsy (MRE). Occurrence of acute post-surgical symptoms, such as prolonged fevers, loss of appetite, diminished level of consciousness, and hemibody weakness is variable across patients. Occurrence can lead to longer hospitalizations, readmissions, and parental dissatisfaction, yet the incidence of, and potential risk factors for developing these problems are not well defined. The study aims to characterize frequency, duration, and potential predictive features of these phenomena in children undergoing disconnective procedures.Methods:
Retrospective review was completed for pediatric patients (< 18 years) with MRE who underwent callosotomy or hemispherotomy from 4/2005-10/2023. Acute post-surgical symptoms included: fever (≥38.5°C) greater than 2 days, loss of appetite (LOA) for more than 2 days, transient worsened hemiparesis, and altered mentation (AM). Fisher’s Exact tests and logistic regression were used to determine relationships between patient characteristics and procedure(s), and elucidate predictive features of phenomena development, respectively.
Results:
A total of 96 patients (43 female, 53 male) were included: 27 CC and 69 hemispherotomy (54 lateral, 15 vertical). Mean surgical age was 7.4 years (SD 4.4), with a mean seizure onset age of 22.1 months (SD 29.2). Patients were hospitalized for a mean 12.3 days (SD 8.1). Frequency of post-surgical symptoms is described in Table 1. On Fisher analysis, hemispherotomy patients were more likely to have fever. Patients with postoperative hydrocephalus were more likely to have prolonged fever (p=0.04, OR 4.1, 95% CI (0.9, 25.1)). Hemispherotomy was predictive of patients developing fever compared to callosotomy on regression modeling (Table 2). In regression modeling for lateral versus vertical hemispherotomy, having a lateral hemispherotomy was predictive of developing fever, as well as patients younger at hemispherotomy were more likely to develop fever. Further, patients with postoperative hydrocephalus will be more likely to have AM (p=0.02, OR 5.8, 95% CI (1.4, 24.4)). No predictive factors were observed for LOA or worsened hemiparesis for any operation.Conclusions:
We describe a cohort of children with MRE who underwent callosotomy or hemispherotomy and elucidate duration and frequency of postoperative phenomena for improved counseling. Hemispherotomy patients were more likely to experience postoperative fevers, particularly lateral-approach, and younger patients. We postulate that phenomena development is secondary to individual patient variability, rather than procedural or demographic characteristics.Funding: None.