INFANT FUNCTIONAL HEMISPHERECTOMY: TECHNICAL CONSIDERATIONS, SAFETY, RESULTS
Abstract number :
1.383
Submission category :
Year :
2003
Submission ID :
3775
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Mary E. Dunn, Frank J. Ritter, Michael D. Frost Neurosurgery, Neurosurgery Associates, Ltd., St. Paul, MN; Epilepsy, Minnesota Epilepsy Group, P.A., St. Paul, MN; Department of Neurology, University of Minnesota, Minneapolis, MN
There were 498 pediatric intracranial epilepsy procedures performed with the Minnesota Epilepsy Surgery Group at Children[apos]s Hospital of St. Paul, Minnesota, between 07/01/1991 and 04/01/2003. There were 21 functional hemispherectomies in this group. Of these, four were infants less than five months of age.
Clinical characteristics of these infants:
1. Clinical epileptic events noted within 24 hours of birth.
2. EEG:
[bull]Unilateral hemispheric epileptiform discharge greater than 100 events per day in each infant.
[bull]Unilateral hemispheric interictal abnormality in each infant.
3. Imaging:
[bull]MRI: Hemimeganencephaly (1), hemisphereic migrational abnormality, dysplasia (3)
[bull]PET: Hypermetabolism anomaly (2)
4. Medical therapies initiated with failure:
[bull]3+ seizure med (4)
[bull]ACTH (2)
[bull]Dietary modifications (2)
Functional hemispherectomy as described by Rasmussen was performed in all infants. One infant, the first of tehse series, required a two stage procedure three days apart due to coagulopathy. The other three had one operative intervention.
[bull]Preoperative average weight was 5.76 kg.
[bull]Average preoperative hemoglobin was 10.5.
[bull]Procedure duration average was 6.5 hours (3) and 13.5 hours in the two stage infant.
[bull]Intraoperative transfusion occurred in one infant. Postoperative transfusion at 24 hours in one infant with a postoperative hemoglobin of 5.3 and no transfusion in two infants with hemoglobin greater than 6.5. These infants were given iron supplementation.
[bull]Average follow-up was 5 years, 8 months.
[bull]All patients are off seizure medications and seizure free at follow-up. One patient (hemimeganencephaly) required reoperation with insular cortex resection at 2.5 years of age. This patient was off medications for one year and had seizure recurrence from remaining insular cortex. He has now been seizure free off medication for 5 years, 6 months.
Infants can safely undergo indicated functional hemispherectomy with minimal morbidity and excellent seizure outcome. Further discussion will include functional outcome in this group as regards Physical Therapy, Occupational Therapy, and Neuropsychological assessments.