ArticleEpilepsia2026
Hemispheric surgery for hemimegalencephaly and hemispheric cortical dysplasia in infants below 12 months of age-A single-center experience.
Article in Epilepsia, 2026. 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
objectiveInfants with early drug-resistant epilepsy caused by hemimegalencephaly (HME) and hemispheric cortical dysplasia (HCD) pose substantial surgical and critical care challenges and have poor seizure outcome prognosis. This study evaluated the safety, complications, and seizure outcomes of hemispheric surgeries in infants younger than 12 months with HME and HCD.
methodsA retrospective analysis included patients younger than 12 months who underwent functional hemispherectomy or hemispherotomy, between 2005 and 2024, at a national epilepsy surgery referral center. Data included demographics, medical history, age at seizure onset and surgery, duration of surgery, intubation and intensive care unit stay duration, blood product requirements, and perioperative and long-term complications. Seizure outcomes were assessed by Engel classification.
resultsFifteen infants (7 male, 8 female) with HME (13) or HCD (2) were analyzed. Median seizure onset was 3 days (interquartile range [IQR] 1.5-8.5), with all experiencing multiple daily seizures. Patients underwent surgery at a median age of 6.4 months (IQR 4.7-9.1) and with a median body weight of 7200 g (IQR 6900-8560; minimum 6400 g; percentiles 2-91). All infants received intraoperative blood transfusions (median 44.8 mL/kg, IQR 23.8-71.5); total blood requirement was 57.3 mL/kg (range 17.5-239.1). One-third (5/15) required more than one circulating volume. No mortalities occurred. Major complications included intracerebral bleeding (2/15, 13.3%) and intraoperative cardiac arrest (1/15, 6.7%). Frequent adverse events included prolonged postoperative intensive care stay of more than 5 days (6/15, 40%) and shunt placement for postoperative hydrocephalus (4/15, 26.7%). Engel class I outcome at 12-month follow-up was achieved in 8 of 15 (53.3%) overall and in 6 of 13 (46%) of HME cases. SIGNIFICANCE: Hemispheric surgery within the first year of life in patients with HME and HCD is feasible but demanding, with substantial perioperative risk. Seizure-freedom rates in HME are favorable, but lower than in other etiologies. Multidisciplinary management remains crucial for optimal outcomes.
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