Abstracts

RATIONALE: To evaluate the indications, surgical type, complications, and outcome in children undergoing hemispherectomy
METHODS: We retrospectively reviewed the charts of all children who underwent hemispherectomy out of 388 epilepsy surgeries performed from 1986-2001. Data analyzed included age at presentation and surgery, examination, neuroimaging results, type of hemispherectomy, pathologic diagnosis, and surgical complications. Outcome was determined by phone calls within the last year to parents of each available patient using a standardized questionnaire.
RESULTS: Fifty five (14%) children, aged 29 days to 19 years, underwent functional (n=51) or anatomic (n=4) hemispherectomy (L=31, R=24) for malformations of cortical development (27), porencephaly/prenatal infarcts (20), Rasmussen[ssquote]s encephalitis (3), Sturge-Weber syndrome (2), trauma (2), and encephalitis (1). All but two had abnormal neuroimaging studies. Operative complications occurred in 19 patients and included infection (7), late hydrocephalus (7), new urinary incontinence (3), stroke (3), other (7), and death (1). Of the 51 who underwent initial functional hemispherectomy, 7 (14%) developed hydrocephalus or edema and required conversion to an anatomic hemispherectomy. 7 died (1-status epilepticus, 1-post-operative complications, 1-hydrocephalus, seizure-free, 1-drowned, seizure free, 1-pneumonia, seizure-free, 2-brainstem infarction). 6 were lost to follow-up. 8 underwent surgery within the last year and were not included in the outcome analysis. Of the 36 with [gt]1yr follow-up, 27 (75%) were seizure free, 8 (22%) were [gt]50% improved and 1 was unchanged. At five year follow-up, 7 (50%) of 14 patients were seizure free. Of those seizure-free at [gt]1 yr, 12 (44%) had cortical dysplasia, 10 (37%) had porencephaly, and 2 (7%) Rasmussen[ssquote]s encephalitis, 1 (4%) each with viral encephalitis, Sturge-Weber syndrome, and trauma. 8 seizure-free children were off anticonvulsant medication. 15 patients had no change post-operatively in the hemiparesis and 9 worsened. Of the 16 with new visual field deficit, 10 had adjusted well, and 6 had not. All parents felt their child benefited from surgery even if they were not seizure free. 28 of 33 felt they would do the surgery again under similar circumstances and 5 were uncertain.
CONCLUSIONS: Hemispherectomy effectively ameliorates seizures in the majority of children with primarily unilateral intractable partial seizures but carries significant morbidity and mortality. Late hydrocephalus may complicate even functional hemispherectomy. Despite the inherent risks of surgery and post-operative deficits, seizure relief and social benefits provide a strong rationale for considering hemispherectomy in children.
Support: Not applicable