gms | German Medical Science

Objective: We present our experience with hemispheric and multilobar disconnective surgery in a series of 67 children and adolescents with drug-resistant epilepsy.

Methods: From 10/1998 - 04/2017 a vertical parasagittal hemispherotomy (HT) according to the technique of O Delalande was performed in 52 pediatric patients (28 male, 24 female; median age 5 yrs, range from 3 months to 19 yrs). Underlying pathologies were perinatal MCA infarction (23), cortical dysplasia 11), other pathologies (18). From 01/ 2005 - 04/2017 a multilobar subhemispheric disconnection was performed in 15 patients (6 male, 9 female; median age 8.9 yrs, range from 1.1 to 19 yrs): temporo-parieto-occipital (TPO) disconnection (12), centro-frontal disconnection (1), temporo-occipital disconnection (1), frontal lobe disconnection combined with a centro-parietal resection (1). Underlying pathologies were a posterior hemispheric dysplasia (7), other pathologies (8). A comprehensive preoperative evaluation was performed in all patients. Outcome was assessed by the Wieser-classification.

Results: In the HT group the follow-up period was 1 months to 19 yrs (median 9.3 yrs). Seizure outcome was Wieser class 1a in 48 children (92.3%) and class 5 in 4 children (7.7%).There was one death on day 4 after surgery due to generalized hyponatriamia induced brain edema. In the subhemispheric disconnection group follow-up was 1 months to 12.5 years (median 6.4 years). Seizure outcome was Wieser class 1a in 12 children (80%), class 1 in 2 (13.4%) and class 4 in 1 (6.6%). In three patients a shunt implantation was necessary after HT, two patients had a temporary EVD and one patient had an Ommaya reservoir. Two previously shunted patients needed shunt revision after frontocentral disconnection (1) and TPO (1).

Conclusion: The hemispheric and subhemispheric multilobar disconnective techniques used in our series proved to be applicable independent on the underlying pathology and the shunting rate is low