Hemispherotomy in the surgical treatment of severe symptomatic epilepsy
Keywords:drug-resistant epilepsy, functional hemispherotomy, neurocognitive disorders, Rasmussen’s encephalitis, cortical dysplasia
Purpose. To evaluate the efficacy of peri-insular functional hemispherotomy (FH) for patients with severe drug-resistant epilepsy.
Materials and Methods. Nine patients underwent peri-insular functional hemispherotomy. The patients included 1 adult (11.1 %) and 8 (88.8 %) children. Patients’ age ranged from 4 to 23 years (mean 9.9 ± 4.2 years). Epilepsy duration ranged from 1.5 to 16 years (mean 7.1 ± 3.1 years), mean seizures frequency was 12.9 ± 6.8 per day; before treatment patients used on average 5.1 ± 2.6 antiepileptic drugs. Diffuse injury of one hemisphere and contralateral hemiparesis were observed in all cases. Follow-up lasted from 1 to 17 months (mean 9.6 ± 1.4 months). Three (33.3 %) patients experienced Rasmussen’s encephalitis, 2 (22.2 %) had multi-lobar cortical malformation, 2 (22.2 %) had complications associated with intracerebral hemorrhage, 1 (11.1 %) patient represented with hypoxic-ischemic encephalopathy and 1 (11.1 %) patient experienced epilepsy associated with PNET resection, chemotherapy and local radiation.
Results. After FH, 7 (77.7 %) children became seizure-free (Engel Class I A), seizure recurrence was observed in one (11.1 %) case in 6 months after surgery. Perioperative complications with following death occurred in one case (11.1 %). Hydrocephalus, which required shunting developed in one (11.1 %) child.
Conclusion. Functional peri-insular hemispherotomy is an effective and safe method for surgical treatment of severe symptomatic epilepsy. Seizure cessation improves psychomotor development and diminishes neurocognitive disorders.
1. French JA, Delanty N. Therapeutic strategies in epilepsy. Oxford: Clin. Publish., 2009. 341 p.
2. Dandy WE. Removal of right cerebral hemisphere for certain tumors with hemiplegia: Preliminary report. Journal of the American Medical Association. 1928 Mar 17;90(11):823-5. [CrossRef]
3. Gardner WJ. Removal of the right cerebral hemisphere for infiltrating glioma. JAMA 1933;101:823-6. [CrossRef]
7. Rasmussen T. Postoperative superficial hemosiderosis of the brain, its diagnosis, treatment and prevention. Trans Am Neurol Assoc. 1973;98:133-7. [PubMed]
8. Devlin AM, Cross JH, Harkness W, Chong WK, Harding B, Vargha-Khadem F, Neville BG. Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence. Brain. Brain. 2003 Mar 1;126(3):556-66. [CrossRef] [PubMed]
9. Ulrich J, Isler W, Vassalli L. [The effect of repeated leptomeningeal hemorrhages on the nervous system (marginal siderosis of the central nervous system)]. Rev Neurol (Paris). 1965 May;112(5):466-71. French. [PubMed]
13. Peacock WJ, Wehby-Grant MC, Shields WD, Shewmon DA, Chugani HT, Sankar R, Vinters HV. Hemispherectomy for intractable seizures in children: a report of 58 cases. Childs Nerv Syst. 1996 Jul;12(7):376-84. [CrossRef] [PubMed]
16. Hoffman HJ. Hemispherectomy. In: Tuxhorn I, Holthausen H, Boenigk H, eds. Paediatric Epilepsy Syndromes and Their Surgical Treatment. London: John Libbey; 1997. P. 739–742.
18. Rasmussen T. Postoperative superficial hemosiderosis of the brain, its diagnosis, treatment and prevention. Trans Am Neurol Assoc. 1973;98:133-7. [PubMed]
19. Rasmussen T. Hemispherectomy for seizures revisited. Can J Neurol Sci. 1983 May;10(2):71-8. [PubMed]
20. Delalande O, Bulteau C, Dellatolas G, Fohlen M, Jalin C, Buret V, Viguier D, Dorfmüller G, Jambaqué I. Vertical parasagittal hemispherotomy: surgical procedures and clinical long-term outcomes in a population of 83 children. Neurosurgery. 2007 Feb;60(2 Suppl 1):ONS19-32; discussion ONS32. [CrossRef] [PubMed]
26. Cook SW, Nguyen ST, Hu B, Yudovin S, Shields WD, Vinters HV, Van de Wiele BM, Harrison RE, Mathern GW. Cerebral hemispherectomy in pediatric patients with epilepsy: comparison of three techniques by pathological substrate in 115 patients. J Neurosurg. 2004 Feb;100(2 Suppl Pediatrics):125-41. [CrossRef] [PubMed]
27. Bahuleyan B, Manjila S, Robinson S, Cohen AR. Minimally invasive endoscopic transventricular hemispherotomy for medically intractable epilepsy: a new approach and cadaveric demonstration. J Neurosurg Pediatr. 2010 Dec;6(6):536-40. [CrossRef] [PubMed]
31. Kwan A, Ng WH, Otsubo H, Ochi A, Snead OC 3rd, Tamber MS, Rutka JT. Hemispherectomy for the control of intractable epilepsy in childhood: comparison of 2 surgical techniques in a single institution. Neurosurgery. 2010 Dec;67(2 Suppl Operative):429-36. [CrossRef] [PubMed]
33. Althausen A, Gleissner U, Hoppe C, Sassen R, Buddewig S, von Lehe M, Schramm J, Elger CE, Helmstaedter C. Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients. J Neurol Neurosurg Psychiatry. 2013 May;84(5):529-36. [CrossRef] [PubMed]
34. Basheer SN, Connolly MB, Lautzenhiser A, Sherman EM, Hendson G, Steinbok P. Hemispheric surgery in children with refractory epilepsy: seizure outcome,complications, and adaptive function. Epilepsia. 2007 Jan;48(1):133-40. [CrossRef] [PubMed]
35. Lew SM, Koop JI, Mueller WM, Matthews AE, Mallonee JC. Fifty consecutive hemispherectomies: outcomes, evolution of technique, complications, and lessons learned. Neurosurgery. 2014 Feb;74(2):182-94; discussion 195. [CrossRef] [PubMed] [PubMed Central]
36. Terra-Bustamante VC, Inuzuka LM, Fernandes RM, Escorsi-Rosset S, Wichert-Ana L, Alexandre V Jr, Bianchin MM, Araújo D, Santos AC, Oliveira dos Santos R, Machado HR, Sakamoto AC. Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients. Childs Nerv Syst. 2007 Mar;23(3):321-6. [CrossRef] [PubMed]
37. Caraballo R, Bartuluchi M, Cersósimo R, Soraru A, Pomata H. Hemispherectomy in pediatric patients with epilepsy: a study of 45 cases with special emphasis on epileptic syndromes. Childs Nerv Syst. 2011 Dec;27(12):2131-6. [CrossRef] [PubMed]
38. Jonas R, Nguyen S, Hu B, Asarnow RF, LoPresti C, Curtiss S, de Bode S, Yudovin S, Shields WD, Vinters HV, Mathern GW. Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes. Neurology. 2004 May 25;62(10):1712-21. [CrossRef] [PubMed]
39. Moosa AN, Gupta A, Jehi L, Marashly A, Cosmo G, Lachhwani D, Wyllie E, Kotagal P, Bingaman W. Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children. Neurology. 2013 Jan 15;80(3):253-60. [CrossRef] [PubMed]
44. Brotis AG, Georgiadis I, Kostas N, Fountas KN. Hemispherectomy: Indications, Surgical Techniques, Complications, and Outcome. J Neurol Neurophysiol. 2015;6:300. [CrossRef]
45. Dorfer C, Czech T, Dressler A, Gröppel G, Mühlebner-Fahrngruber A, Novak K, Reinprecht A, Reiter-Fink E, Traub-Weidinger T, Feucht M. Vertical perithalamic hemispherotomy: a single-center experience in 40 pediatric patients with epilepsy. Epilepsia. 2013 Nov;54(11):1905-12. [CrossRef] [PubMed]
46. Baumgartner JE, Blount JP, Blauwblomme T, Chandra PS. Technical descriptions of four hemispherectomy approaches: From the Pediatric Epilepsy Surgery Meeting at Gothenburg 2014. Epilepsia. 2017 Apr;58 Suppl 1:46-55. [CrossRef] [PubMed]
47. Limbrick DD, Narayan P, Powers AK, Ojemann JG, Park TS, Bertrand M, Smyth MD. Hemispherotomy: efficacy and analysis of seizure recurrence. J Neurosurg Pediatr. 2009 Oct;4(4):323-32. [CrossRef] [PubMed]
48. Binder DK, Schramm J. Multilobar resections and hemispherectomy. In: Engel J Jr, Pedley TA, Aicardi J, editors. Epilepsy: a comprehensive textbook. Lippincott Williams & Wilkins; 2008. P. 1879–1890. Available from: https://pdfs.semanticscholar.org/1758/8f2f2affb26e5ac437702e13af64499fd522.pdf
How to Cite
Copyright (c) 2019 Kostyantyn R. Kostiuk, Valeriy V. Cheburakhin, Viacheslav M. Buniakin
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.