Abstracts

Rationale: Hemispherotomy, or functional hemispherectomy, is known for its high seizure control rate in hemispheric epilepsy, due to the extended extent of isolating the epileptic discharge spreading pathyway, but also its unihemispheric dysfunction is mostly unavoidable. In hopes of achieving comparable results of hemispherotomy while reducing the risk of such complications, extended multi-lobar resection or disconnection, which may be otherwise termed as "sub-total hemispherotomy," has been performed in selected patients and this study aims to review their seizure outcome and other consequences. Methods: Amongst the patients who have undergone epilepsy surgery at Severance Children's Hospital in Seoul from year 2005 to 2013, twelve patients with history of extended multi-lobar surgery have had their medical records retrospectively reviewed. Three patients have reached multi-lobar disconnected state through two or more stages over the span of 2 to 3 years, and the procedure was done in one step or during the two surgical phase of 1 week period in the rest of the nine patients. Results: The extended multi-lobar epilepsy surgery included frontal lobectomy with posterior quadrantectomy(F-PQ)(5/12, 41.7%), fronto-temporo-occipital resection(2/12, 16.7%), F-PQ with additional corpus-callosotomy(CC) (2/12, 16.7%) and multiple lobectomy with CC (3/12, 25.0%). 66.7% of the patients were seizure free at 3 post-operative months, 41.7% at 1 year. After following up of mean 3.5 years, 41.7% of the patients were seizure free. After surgery and rehabilitation in some patients, 75% reported no significant functional loss, such as hemiparesis. Those who have had frontal lobectomy with posterior quadrantectomy showed better seizure outcome and less unilateral dysfunction than other surgical groups. Conclusions: With reduced unihemispheric complications, "sub-total hemispherotomy," especially frontal lobectomy with posterior quadrantectomy is an effective surgical treatment for hemispheric epilepsy, with comparable seizure outcome.