Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2011;7(1):12-17.
Published online June 30, 2011.
Surgical Experiences of Hemispherectomy in Pediatric Epilepsy
Min Seok Byun, Yong Soon Hwang, Sang Keun Park, Hyung Shik Shin, Tae Hong Kim, Jun Jae Shin
Department of Neurosurgery, Sanggye Paik Hospital, Inje University, Seoul, Korea
Abstract
Objective
The authors performed the hemispherectomy in 8 cases of pediatric intractable epilepsy from 1998 to 2005. We evaluate their seizure and functional outcomes with long-term follow-up periods (6-11years), and describe lessons from the surgical experiences. Materials and Methods: There were 4 girls and 4 boys, and their mean age was 4.4years (8months-11years). One Rasmussen's encephalitis, 2 hemispheric malformations of cortical development (MCD), 4 Sturge-Weber syndromes (SWS), and a post-traumatic hemispheric atrophy were in this series. Five patients were involved in the right hemisphere and three were involved in the left hemisphere. Earlier two cases underwent functional hemispherectomy (FH) and following 6 cases underwent peri-insular hemispherotomy (PIH). Mean follow-up period was 9.1years (6-13years).
Results
Out of 8 patients, six are doing well so far showing satisfactory seizure control ; Engel class I in 5 patients and II in 1 patient. Remarkable developmental catch-up was noted also in 5 patients who originally have retardation. The first and the last cases of this series became vegetative state after the surgery because of postoperative brain swelling of unknown etiology and postoperative failure of keeping airway causing irreversible hypoxic brain injury respectively. Lessons from these surgical experiences were that 1) the free edge along falx and tentorium was very useful guideline to sever completely the medial wall of trigonal zone of lateral ventricle, 2) precautious perioerative care is imperative for handling the pediatric cases.
Conclusion
We think that the hemispherectomy is very effective surgical procedure in selective hemiconvulsion-hemiplegia-epilepsy syndrome, but we emphasize that thorough anatomical knowledge of cerebral hemisphere and meticulous perioperative management are essential prerequisites to achieve good results.
Key Words: Hemispherectomy, Seizures, Epilepsy, Outcome.


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