Article
Peri-insular hemispherotomy versus functional hemispherectomy for the treatment of hemispheric intractable epilepsy in hemimegalencephaly
Peri-insuläre Hemisphärotomie versus funktionelle Hemisphärektomie zur Behandlung der hemisphärischen pharmakoresistenten Epilepsie bei Hemimegalencephalie
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Published: | May 4, 2005 |
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Outline
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Objective
To compare the surgical and clinical results of the functional hemispherectomy and peri-insular hemispherotomy applied to the treatment of hemispheric intractable epilepsy in hemimegalencephaly patients.
Methods
Retrospective analysis of 27 hemimegalencephaly patients who underwent consecutively functional hemispherectomy and peri-insular hemispherotomy in our department between 1990 and 2004. The mean age of the patients at the time of operation was 15 months. 15 patients were infants at the time of operation (56%), 11 patients were between 1 and 3 years old (41%), and one patient was older than 3 years. The male- female ratio was 2:1. The mean epilepsy duration before the operation was 15 months. The functional hemispherectomy consisted of a big central region tissue resection which was followed by temporal lobectomy, amygdalohippocampectomy, callosotomy and undercutting disconnection of frontal and occipital lobes. In the peri-insular hemispherotomy we achieved the disconnection of the hemisphere from within the lateral ventricle through smaller craniotomies and shorter operating times. Follow-up examination was performed at a mean of 7 years and 9 months after surgery and the epilepsy outcome is evaluated according to the Engels classification.
Results
12 patients underwent functional hemispherectomy and 15 patients peri-insular hemispherotomy. The epilepsy outcome is 67% seizure free or almost seizure free (Engels I and II). Additionally 15% of cases benefited from the operation (Engels III). The rates of incomplete disconnection have been reduced by the hemispherotomy (13% from 25% in hemispherectomy). 11% of cases needed a shunt implantation. We had one peri-operative death.
Conclusions
The peri-insular hemispherotomy can be performed in patients with hemimegalencephaly, despite the bigger brain volume. A better disconnection is achieved with less brain resection. The duration of hospitalisation is reduced. The early operation is beneficial for the development of the children, taking full advantage of the brain plasticity in this age.