gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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

Meeting Abstract

Suche in Medline nach

  • corresponding author V. Zountsas - Neurochirurgische Klinik, Krankenanstalten Gilead Bethel Bielefeld
  • H. W. Pannek - Neurochirurgische Klinik, Krankenanstalten Gilead Bethel Bielefeld
  • F. Oppel - Neurochirurgische Klinik, Krankenanstalten Gilead Bethel Bielefeld

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc10.05.-05.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0109.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Zountsas et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

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.