Artikel
Functional hemispherectomy and peri-insular hemispherotomy for the treatment of hemispheric intractable epilepsy
Funktionelle Hemisphärektomie und peri-insuläre Hemisphärotomie zur Behandlung der hemisphärischen pharmakoresistenden Epilepsie
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Autoren
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V. Zountsas
- Neurochirurgische Klinik, Krankenanstalten Gilead Bethel Bielefeld
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H. W. Pannek
- Neurochirurgische Klinik, Krankenanstalten Gilead Bethel Bielefeld
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F. Oppel
- Neurochirurgische Klinik, Krankenanstalten Gilead Bethel Bielefeld
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
We report a series of 84 patients suffering from severe hemispheric intractable epilepsy, who were treated in our department between May 1990 and November 2004, by either functional hemispherectomy or peri-insular hemispherotomy.
Methods
Retrospective analysis of the 84 consecutive operated cases with focus on the surgical and clinical results. 22 patients were infants at the time of operation (26%), 26 patients were between 1 and 3 years old (32%), 26 patients were between 3 and 14 years old (31%), 7 patients between 14 and 17 years old (8%) and only 2 patients older than 19 years. The indication for hemispherectomy was set in 49 cases with congenital developmental etiologies (27 hemimegalencephaly, 17 cortical dysplasia and 7 Sturge-Weber cases) as well as in 35 cases with acquired lesions (13 Rasmussen encephalitis, 19 porencephaly after MCA-infarct and 3 other encephaloclastic lesions). 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, shorter operating times and less blood loss. The epilepsy outcome is evaluated according to the Engels classification, with mean follow-up of 6,5 years.
Results
28 patients underwent functional hemispherectomy and 56 patients peri-insular hemispherotomy. The advantages of hemispherotomy are obvious in the porencephalic and the atrophic lesions. The epilepsy outcome is 71% seizure free or almost seizure free. Additionally 17% of cases benefited from the operation (Engels III). The rates of incomplete disconnection have been reduced by the hemispherotomy. 7% of cases needed a shunt implantation. The mortality was 2,3%.
Conclusions
The peri-insular hemispherotomy can be safely applied in all etiologies of hemispheric intractable epilepsy. In comparison to functional hemispherectomy, it has better surgical and clinical results. The anesthesiological management is of cardinal importance for the reduction of morbidity and hospitalisation. The early operation is beneficial for the development of the children, taking full advantage of the brain plasticity in this age.
