Hemispherotomy for pediatric epilepsy: a systematic review and critical analysis

Lopez, Alexander M.; Badger, Clint; Kennedy, Benjamin C.

doi:10.1007/s00381-021-05176-x

Cited by 19 publications

(21 citation statements)

References 43 publications

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“…Psychomotor development may be delayed or regressed, particularly in patients with frequent epileptic discharges in the unaffected hemisphere. 2 ) In addition, psychomotor development depends on the timing of surgical intervention. Although epileptic discharges and seizures are suppressed after hemispherotomy, not many patients show normal development.…”

Section: Discussionmentioning

confidence: 99%

“… 1 ) In addition, it is expected to contribute to growth and brain development by protecting the contralateral cerebral hemisphere. 2 ) In theory, hemispherotomy involves complete disconnection of neural fibers from the contralateral cerebral hemisphere and ipsilateral basal ganglia/thalamus. This surgical technique has been repeatedly refined to overcome various complications, establishing hemispherotomy in its current form.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Strategy for Hemispherotomy

Matsuo

Fujimoto

2023

Neurol. Med. Chir.(Tokyo)

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Hemispherotomy is a radical treatment for drug-resistant epilepsy that targets developmental, acquired, and progressive diseases with widespread epileptogenic regions in one cerebral hemisphere. Currently, two main approaches are utilized after repeated improvements: lateral and vertical approaches. With the lateral approach, the surgical field is wide, and the approach to the lateral ventricle is relatively easy. On the other hand, the vertical approach has the advantage of reducing intraoperative bleeding and operating time as the resection line of the radial fiber is short, and understanding the three-dimensional anatomy is relatively easy. The lateral approach is generally used for atrophic lesions, whereas the vertical approach is for hypertrophic lesions. Hemispherotomy is expected to not only suppress epileptic seizures but also improve psychomotor development by protecting the unaffected cerebral hemisphere. However, this method is one of the most invasive surgeries in epilepsy surgery, and it is important to fully consider its indications. Furthermore, understanding the neural fiber pathway is important for actual surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical Strategy for Hemispherotomy

Matsuo

Fujimoto

2023

Neurol. Med. Chir.(Tokyo)

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“…Significant contralateral MRI findings were associated with seizure recurrence in our cohort, thus supporting the impact of MRI abnormalities on postsurgical seizure outcome. 4,19,20 However, the criteria for "significant" MRI abnormalities have not always been clearly defined in previous studies, and often remain dependent on the subjective interpretation of the observer. This ambiguity may underpin disparities reported in past studies 3,4,16 and is expected to evolve further with the use of improved neuroimaging techniques.…”

Section: Determinants Of Seizure Outcomementioning

confidence: 99%

Not surgical technique, but etiology, contralateral MRI, prior surgery, and side of surgery determine seizure outcome after pediatric hemispherotomy

et al. 2023

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Objective:We aimed to assess determinants of seizure outcome following pediatric hemispherotomy in a contemporary cohort. Methods:We retrospectively analyzed the seizure outcomes of 457 children who underwent hemispheric surgery in five European epilepsy centers between 2000 and 2016. We identified variables related to seizure outcome through multivariable regression modeling with missing data imputation and optimal group matching, and we further investigated the role of surgical technique by Bayes factor (BF) analysis.Results: One hundred seventy seven children (39%) underwent vertical and 280 children (61%) underwent lateral hemispherotomy. Three hundred forty-four children (75%) achieved seizure freedom at a mean follow-up of 5.1 years (range 1 to 17.1). We identified acquired etiology other than stroke (odds ratio [OR] 4.4, 95% confidence interval (CI) 1.1-18.0), hemimegalencephaly (OR 2.8, 95% CI 1.1-7.3), contralateral magnetic resonance imaging (MRI) findings (OR 5.5, 95% CI 2.7-11.1), prior resective surgery (OR 5.0, 95% CI 1.8-14.0), and left hemispherotomy (OR 2.3, 95% CI 1.3-3.9) as significant determinants of seizure recurrence.

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“…The hemispherectomy or hemispherotomy is widely utilized to treat intractable epilepsy [1][2][3]. However, high muscle tone on the opposite side follows the epilepsy surgery and hinders ambulation after the procedure.…”

Section: Introductionmentioning

confidence: 99%

Selective Dorsal Rhizotomy For Treatment of Spasticity After Hemispherectomy In Children: A Case Report

Park¹,

Joh²,

Smyth³

et al. 2023

Cureus

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Performing a hemispherotomy or hemispherectomy is known to treat medically intractable epilepsy successfully, yet contralateral hemiparesis and increased muscle tone follow the epilepsy surgery. Spasticity and coexisting dystonia presumably cause the increased muscle tone in the lower extremity on the opposite side of epilepsy surgery. However, the extent of the role of spasticity and dystonia in high muscle tone is unknown. A selective dorsal rhizotomy is performed to reduce spasticity. If a selective dorsal rhizotomy is performed in the affected patient and muscle tone is reduced, the high muscle tone is not due to dystonia. Two children, who previously underwent a hemispherectomy or hemispherotomy, had a selective dorsal rhizotomy (SDR) performed in our clinic. Both children underwent orthopedic surgery to treat heel cord contractures. To study the extent of the role of spasticity and dystonia in high muscle tone, the mobility of the two children was examined pre-and post-SDR. The children had follow-ups 12 months and 56 months after SDR to study long-term effects. Before SDR, both children showed signs of spasticity. The SDR procedure removed spasticity, and muscle tone in the lower extremity became normal. Importantly, dystonia did not surface after SDR. Patients started independent walking less than two weeks after SDR. Sitting, standing, walking, and balance improved. They could walk longer distances while experiencing less fatigue. Running, jumping, and other more vigorous physical activities became possible. Notably, one child showed voluntary foot dorsiflexion that was absent before SDR. The other child showed improvement in voluntary foot dorsiflexion that was present before SDR. Both children maintained the progress at the 12 and 56month follow-up visits. The SDR procedure normalized muscle tone and improved ambulation by removing spasticity. The high muscle tone following the epilepsy surgery was not due to dystonia.

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Hemispherotomy for pediatric epilepsy: a systematic review and critical analysis

Cited by 19 publications

References 43 publications

Surgical Strategy for Hemispherotomy

Surgical Strategy for Hemispherotomy

Not surgical technique, but etiology, contralateral MRI, prior surgery, and side of surgery determine seizure outcome after pediatric hemispherotomy

Selective Dorsal Rhizotomy For Treatment of Spasticity After Hemispherectomy In Children: A Case Report

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