ReviewChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2025
Two-year outcomes following modified transsylvian peri-insular hemispherotomy.
Review in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeHemispherotomy is an effective treatment for well-selected patients with drug-resistant hemispheric epilepsy. Successful hemispherotomy leading to seizure cessation has been associated with improved neurodevelopmental outcomes and reduced healthcare utilization. This study reports seizure outcomes and complications in a large, consecutive, single-surgeon series of pediatric hemispherotomy cases using a surgical approach with modifications to previously-reported techniques.
methodsAll patients undergoing transsylvian peri-insular hemispherotomy for drug-resistant hemispheric epilepsy between May 2017 and April 2021 by a single surgeon were prospectively enrolled in an epilepsy surgery registry. With retrospective review of medical records, data were collected on baseline characteristics (demographics, epilepsy history, anti-seizure medications, neurodevelopmental status, EEG features, and imaging characteristics), operative complications, hospital course, and seizure outcomes (Engel scale at 12- and 24-month follow-up).
resultsAll 32 consecutive patients (aged 15 months-19 years) were seizure-free (Engel Class 1) 12 and 24 months after hemispherotomy. At 12 months, 31 patients (97%) had Engel Class 1A outcomes, and 1 patient (3%) had an Engel Class 1D outcome. These results were maintained through 24-month follow-up. Among 31 patients taking anti-seizure medications before surgery, 22 (71%) were weaned off all agents by 24 months. One patient (3%) developed post-operative hydrocephalus requiring ventriculoperitoneal shunt placement.
conclusionIn an etiologically heterogeneous cohort of patients undergoing hemispherotomy for drug-resistant epilepsy, a modified transsylvian peri-insular technique led to high rates of sustained seizure freedom with minimal complications.
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