gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Hemispherectomy in adults

Meeting Abstract

Suche in Medline nach

  • D. Delev - Neurochirurgische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
  • M. von Lehe - Neurochirurgische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland
  • J. Schramm - Neurochirurgische Klinik, Universitätsklinikum Bonn, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.13.03

DOI: 10.3205/11dgnc099, URN: urn:nbn:de:0183-11dgnc0990

Veröffentlicht: 28. April 2011

© 2011 Delev 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 vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Hemispherectomies are performed less frequently in adults and knowledge about these patients and results for functional hemispherectomies are less well-known. We therefore reviewed our database for adult hemispherectomy patients with the intent to describe the patient group and outcome.

Methods: This is an analysis of 27 adult patients who underwent functional hemispherectomy in a total series of 130 patients between 1989 and 2009. Data were collected prospectively by annual or bi-annual follow-up. Mean age at operation was 29 yrs. (range 19–54). Patients with follow-up under 12 months (n=2) were excluded from most analyses. One patient died after having been seizure-free for four months postoperatively in a traffic accident.

Results: Etiologies were post-infarction cyst or porencephaly n=15, post-encephalitic with or without cyst formation n=4, Rasmussen encephalitis/other acute encephalitis n=2, hemiatrophy n=2, hemimegalencephaly n=1, dysplasia or cortical malformations n=2. Four patients were operated on using Rasmussen's functional hemispherectomy technique, three using our own perisylvian transcortical method, and 17 using the transsylvian keyhole disconnection procedure (Schramm et al). Follow-up over one year was available in 24 cases (mean 6 yrs, range 2–12 yrs). Engel class I outcome was achieved in 88% of cases, 88% in the transsylvian technique, 100% in the transcortical perisylvian technique, and 75% in the Rasmussen technique. Of the 24 patients 17 (71%) remained Engel class I after surgery, four (16%) were initially not seizure-free but became Engel class I later, and three (12%) were initially seizure-free and later had seizures again. Five patients developed surgical complications related to the hemispherotomy: one wound infection, subdural hematoma, and infection of a pre-existing shunt. Two late surgical complications: one intraventricular cyst requiring resection and one patient required a shunt with several revisions. One postoperative pneumonia and one recurrence of depression and episodes of fear in a patient with previous psychiatric illness. None of the complications led to permanent sequelae except for the one case with a new shunt implantation. The shunt rate is thus 4%.

Conclusions: Outcome of functional hemispherectomy in adults appears to be rewarding with an Engel class I outcome of 88%. Despite a relatively high rate of complications, none of those led to significant deficits. Later reccurrence of seizures occurred in 12%. It appears worthwhile to perform functional hemispherectomies in adults.