Child's Nervous System

, Volume 23, Issue 3, pp 321–326 | Cite as

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

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

Hemispherotomy Epilepsy surgery in children Outcome of hemispheric surgery 

Notes

Acknowledgements

The authors thank the epilepsy fellows, neurology residents, and staff of the Epilepsy Outpatient Clinics and Video-EEG Monitoring Unit of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto/USP. This work was supported by FAPESP, CNPq, and FAEPA.

References

  1. 1.
    Carson BS, Javedan SP, Freeman JM, Vining EP, Zuckerberg AL, Lauer JA, Guarnieri M (1996) Hemispherectomy: a hemidecortication approach and review of 52 cases. J Neurosurg 84(6):903–911PubMedCrossRefGoogle Scholar
  2. 2.
    Chugani HT, Shewmon DA, Peacock WJ, Shields WD, Mazziotta JC, Phelps ME (1988) Surgical treatment of intractable neonatal-onset seizures: the role of positron emission tomography. Neurology 38(8):1178–1188PubMedGoogle Scholar
  3. 3.
    Dandy W (1928) Removal of right cerebral hemisphere for certain tumor with hemiplegia. JAMA 90:823–825Google Scholar
  4. 4.
    Delalande O, Pinard J-M, Basdevant C et al (1992) Hemispherotomy: a new procedure for central disconnection. Epilepsia 33(Suppl 3):99–100Google Scholar
  5. 5.
    Devlin AM, Cross JH, Harkness W, Chong WK, Harding B, Vargha-Khadem F, Neville BG (2003) Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain 126(Pt 3):556–566PubMedCrossRefGoogle Scholar
  6. 6.
    Döring S, Cross H, Boyd S, Harkness W, Neville B (1999) The significance of bilateral EEG abnormalities before and after hemispherectomy in children with unilateral major hemisphere lesions. Epilepsy Res 34(1):65–73PubMedCrossRefGoogle Scholar
  7. 7.
    Duchowny M, Jayakar P, Resnick T, Harvey AS, Alvarez L, Dean P, Gilman J, Yaylali I, Morrison G, Prats A, Altman N, Birchansky S, Bruce J (1998) Epilepsy surgery in the first three years of life. Epilepsia 39(7):737–743PubMedCrossRefGoogle Scholar
  8. 8.
    Engel J Jr (1993) Protocols for the University of California, Los Angeles. In: Engel J Jr (ed) Surgical treatment of Epilepsies. Raven, New York, pp 743–745Google Scholar
  9. 9.
    Gonzalez-Martinez JA, Gupta A, Kotagal P, Lachhwani D, Wyllie E, Luders HO, Bingaman WE (2005) Hemispherectomy for catastrophic epilepsy in infants. Epilepsia 46(9):1518–1525PubMedCrossRefGoogle Scholar
  10. 10.
    Jonas R, Nguyen S, Hu B, Asarnow RF, LoPresti C, Curtiss S, de Bode S, Yudovin S, Shields WD, Vinters HV, Mathern GW (2004) Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes. Neurology 62(10):1712–1721PubMedGoogle Scholar
  11. 11.
    Kossoff EH, Vining EP, Pillas DJ, Pyzik PL, Avellino AM, Carson BS, Freeman JM (2003) Hemispherectomy for intractable unihemispheric epilepsy etiology vs outcome. Neurology 61(7):887–890PubMedGoogle Scholar
  12. 12.
    Maehara T, Shimizu H, Kawai K, Shigetomo R, Tamagawa K, Yamada T, Inoue M (2002) Postoperative development of children after hemispherotomy. Brain Dev 24(3):155–160PubMedCrossRefGoogle Scholar
  13. 13.
    Ohtsuka Y, Ohno S, Oka E (1999) Electroclinical characteristics of hemimegalencephaly. Pediatr Neurol 20(5):390–393PubMedCrossRefGoogle Scholar
  14. 14.
    Peacock WJ, Wehby-Grant MC, Shields WD, Shewmon DA, Chugani HT, Sankar R, Vinters HV (1996) Hemispherectomy for intractable seizures in children: a report of 58 cases. Childs Nerv Syst 12(7):376–384PubMedCrossRefGoogle Scholar
  15. 15.
    Pulsifer MB, Brandt J, Salorio CF, Vining EP, Carson BS, Freeman JM (2004) The cognitive outcome of hemispherectomy in 71 children. Epilepsia 45(3):243–254PubMedCrossRefGoogle Scholar
  16. 16.
    Shimizu H, Maehara T (2000) Modification of peri-insular hemispherotomy and surgical results. Neurosurgery 47(2):367–373PubMedCrossRefGoogle Scholar
  17. 17.
    Smith JR, Fountas KN, Lee MR (2005) Hemispherotomy: description of surgical technique. Childs Nerv Syst 21(6):466–472PubMedCrossRefGoogle Scholar
  18. 18.
    Smith SJ, Andermann F, Villemure JG, Rasmussen TB, Quesney LF (1991) Functional hemispherectomy: EEG findings, spiking from isolated brain postoperatively, and prediction of outcome. Neurology 41(11):1790–1794PubMedGoogle Scholar
  19. 19.
    Villemure JG, Mascott CR (1995) Peri-insular hemispherotomy: surgical principles and anatomy. Neurosurgery 37:975–981PubMedCrossRefGoogle Scholar
  20. 20.
    Yoshioka H, Hasegawa K, Sakamoto T, Kihara M, Masuda A, Adachi S, Sawada T, Shimizu H (1999) Modified functional hemispherectomy in hemimegalencephaly. Brain Dev 21(2):125–128PubMedCrossRefGoogle Scholar
  21. 21.
    Wyllie E, Comair YG, Kotagal P, Bulacio J, Bingaman W, Ruggieri P (1998) Seizure outcome after epilepsy surgery in children and adolescents. Ann Neurol 44(5):740–748PubMedCrossRefGoogle Scholar

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

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