Child's Nervous System

, Volume 23, Issue 3, pp 321–326

Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients

  • Vera Cristina Terra-Bustamante
  • Luciana Midori Inuzuka
  • Regina Maria França Fernandes
  • Sara Escorsi-Rosset
  • Lauro Wichert-Ana
  • Veriano AlexandreJr.
  • Marino M. Bianchin
  • David Araújo
  • Antônio Carlos Santos
  • Ricardo Oliveira dos Santos
  • Helio Rubens Machado
  • Américo Ceiki Sakamoto
Original Paper

DOI: 10.1007/s00381-006-0212-6

Cite this article as:
Terra-Bustamante, V.C., Inuzuka, L.M., Fernandes, R.M.F. et al. Childs Nerv Syst (2007) 23: 321. doi:10.1007/s00381-006-0212-6

Abstract

Background

Hemispheric brain lesions are commonly associated with early onset of catastrophic epilepsies and multiple seizure types. Hemispheric surgery is indicated for patients with unilateral intractable epilepsy. Although described more than 50 years ago, several new techniques for hemispherectomy have only recently been proposed aiming to reduce operatory risks and morbidity.

Materials and methods

We present the clinical characteristics, presurgical workup, and postoperative outcome of a series of pediatric patients who underwent hemispherectomy for medically intractable epileptic seizures. Thirty-nine patients with medically intractable epilepsy underwent surgery from 1996 to 2005.

Results and discussion

We analyzed demographic data, interictal and ictal EEG findings, age at surgery, surgical technique and complications, and postsurgical seizure outcome. There were 74.4% males. Tonic and focal motor seizures occurred in 30.8 and 20.5% of the patients. Most frequent etiologies were Rasmussen encephalitis (30.8%) and malformation of cortical development (23.1%). Postsurgical outcomes were Engel classes I and II for 61.5% of the patients. In general, 89.5% of the patients exhibited at least a 90% reduction in seizure frequency. All patients had acute worsening of hemiparesis after surgery. Basically, two surgical techniques have been employed, both with similar results, although a trend has been noted toward one of the procedures which produced consistently complete disconnection. Patients with hemispheric brain lesions usually have abnormal neurological development and intractable epilepsy. When video-EEG monitoring and magnetic resonance imaging show unilateral disease, the patient may evolve with a good surgical outcome. We showed that a marked reduction in seizure frequency may be achieved, with acceptable neurological impairments.

Keywords

HemispherotomyEpilepsy surgery in childrenOutcome of hemispheric surgery

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Vera Cristina Terra-Bustamante
    • 1
  • Luciana Midori Inuzuka
    • 1
  • Regina Maria França Fernandes
    • 1
  • Sara Escorsi-Rosset
    • 1
  • Lauro Wichert-Ana
    • 1
  • Veriano AlexandreJr.
    • 1
  • Marino M. Bianchin
    • 1
  • David Araújo
    • 3
  • Antônio Carlos Santos
    • 3
  • Ricardo Oliveira dos Santos
    • 2
  • Helio Rubens Machado
    • 2
    • 4
  • Américo Ceiki Sakamoto
    • 1
  1. 1.Department of Neurology, Psychiatry and Psychology,Ribeirão Preto School of MedicineUniversity of São PauloRibeirão PretoBrazil
  2. 2.Department of Neurosurgery, Ribeirão Preto School of MedicineUniversity of São PauloRibeirão PretoBrazil
  3. 3.Department of Radiology, Ribeirão Preto School of MedicineUniversity of São PauloRibeirão PretoBrazil
  4. 4.Departmento de Neurologia, Centro de Cirurgia de Epilepsia-CIREPCampus UniversitárioRibeirão Preto-SPBrazil