Long-Term Orthopedic Outcomes in Pediatric Hemispherotomy
Abstract number :
2.326
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2023
Submission ID :
580
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Emily Harford, MA – University of Pittsburgh
Taylor Abel, MD – Associate Professor, Neurological Surgery, University of Pittsburgh
Rationale:
Hemispherotomy is a surgical intervention for patients with drug-resistant epilepsy and involves hemispheric removal (anatomic) or disconnection (functional). Despite well-documented effects on seizure control and increasing reports of minimal impact on developmental outcomes, some medical outcomes remain poorly understood. The purpose of this study is to describe orthopedic outcomes associated with pediatric hemispherotomy at the Children’s Hospital of Pittsburgh.
Methods:
We conducted a retrospective review of patients who underwent hemispherotomy at Children’s Hospital of Pittsburgh from 2001 through 2023. Data on presence of spasticity, use of upper and lower extremity orthotics, and orthopedic surgery intervention were collected for each patient where available pre-operatively and at 1, 5, 10, and 15 years post-operatively.
Results:
A total of 38 patients were identified and 36 were included in the final cohort. One patient was excluded due to lack of data and one due to mortality. Data were available for 29 patients pre-operatively, 25 at 1-year post-op, 14 at 5-years, 13 at 10-years, and 7 at 15-years. Pre-operatively 19/29 (66%) patients presented with spasticity, 46% used orthotics, and one patient had undergone orthopedic surgery. Reports of spasticity rose to 22/25 (88%) at one year and remained stable in 13/14 (93%), 12/13 (92%), and 7/7 (100%) patients at 5, 10, and 15 years post-op, respectively. Use of orthotics increased to 18/24 (75%) at one year, 13/14 (93%) at five years and 100% at ten and 15 years post-op. No patients underwent orthopedic surgery intervention in the first year post-op. This proportion increased to 5/14 (36%) by five years, 7/13 (54%) by ten years, and 5/7 (71%) by fifteen years.
Conclusions:
Our findings show that hemispherotomy patients may need pre- and post-operative orthopedic care including orthotics and surgical intervention. While the proportion of patients reported with spasticity remained similar over follow-up intervals, the proportion that required orthotics and surgical intervention increased. This study is limited by its small sample size and retrospective nature, yet suggests that the underlying etiology and neurological sequelae in hemispherotomy patients are associated with musculoskeletal impact requiring the long-term support of orthopedic services.
Funding:
This research was supported by NIH-NIDCD (R21DC019217).
Surgery