gms | German Medical Science

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.