SURGICAL OUTCOME AFTER HEMISPHERECTOMY
Abstract number :
1.454
Submission category :
Year :
2003
Submission ID :
1931
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Pedro P. Mariani, Jose A. Burattini, Arthur Cukiert, Rodio Brandao, Lauro Ceda, Leila Frayman, Valeria A. Mello, Carla Baise, Meire Argentoni, Cristine M. Baldauf, Cassio R. Forster Neurology and Neurosurgery, Hospital Brigadeiro, Sao Paulo, SP, Brazil; N
Hemispherectomy has been used as treatment modality for refractory epilepsy for many years. More recently, hemispheric epileptic syndromes have been better defined and the patient[rsquo]s population submitted to this type of procedure has become increasingly homogenized. Presently, the main epileptic syndromes submitted to this type of surgery are Rasmussen syndrome, hemiplegic[rsquo]s syndromes, hemispheric cortical dysplasia and Sturge-Weber syndrome.
Thirty-three patients submitted to functional hemispherectomy were studied. Sixteen has Rasmussen syndrome, 13 congenital hemiplegic[rsquo]s syndromes, 1 Sturge-Weber syndrome and 3 cortical dysplasia. Surgery consisted of large frontotemporoparietal resection, total callosotomy and disconnection of the remaining frontal and occipital poles. Thirty patients had contralateral hemiplegia preoperatively. All patients had refractory epilepsy with frequent daily seizures; age ranged from 11 months to 29 years (m=8,9 years) and follow-up time from 6 months to 9 years (m=3,5 years).
Twenty-nine patients have been seizure-free after surgery. The other 4 patients had at least 80% of seizure[rsquo]s frequency improvement. Three patients needed ventriculo-peritoneal shunting during late follow-up. The 3 patients that were not hemiplegics preoperatively were left with deficit postoperatively (2 with Rasmussen syndrome and 1 with cortical dysplasia); in the others, there was no further neurological deterioration. Thirty-two patients disclosed an aseptic meningitis postoperative syndrome characterized by high fever, meningismus and preserved neurological status, with a mean duration of 2 weeks. There was no surgical mortality.
Functional hemispherectomy is an effective and safe surgical procedure in selected patient[rsquo]s population. Surgical morbidity and mortality are very low. Special attention should be paid to patients with cortical dysplasia with or without hemimegalencephaly (HME). In those with HME there should be a compromise between resection and disconnection to avoid unnecessary empty spaces. Patients with cortical dysplasia might bear residual neurological function within the dysplastic cortex.
[Supported by: Sao Paulo Secretary of Health]