Hemispherotomy and functional hemispherectomy: Indications and outcome

Carlo Efisio Marras, Tiziana Granata, Angelo Franzini, Elena Freri, Flavio Villani, Marina Casazza, Marco De Curtis, Francesca Ragona, Paolo Ferroli, Ludovico D'Incerti, Alexander Pincherle, Roberto Spreafico, Giovanni Broggi

Research output: Contribution to journalArticle

Abstract

Peri-insular hemispherotomy is a disconnective procedure that enables functional isolation of single or multiple epileptogenic regions largely involving one hemisphere.This report is based on a consecutive series of 13 pediatric patients affected by refractory hemispheric epilepsy studied and operated on at the Neurological Institute " C. Besta" of Milan. In all patients seizures were focal with polymorphic features and daily frequency. Preoperative electro-clinical and MRI data were suggestive of Rasmussen's encephalitis in 6 cases, hemimegalencephaly in 2, hemispheric cortical malformation in 3, perinatal stroke in 2 cases. Mean age at surgery was 7.3 years.The postoperative course was good for all patients. Mean follow-up period was 4.5 years (range 2-7 years). After hemispherotomy, 8 patients were Engel Class I and five continued to have seizures and were classified as Engel Class II (1 case) III (3 cases) or IV (1 case). The outcome results varied according to the etiology; the best results were achieved in patients with Rasmussen encephalitis and perinatal vascular strokes with 75% classified in Engel Class I. Three patients underwent a second surgery because of persistent seizures and evidence of incomplete disconnection; two out of three patients had hemimegalencephaly, and did not improve; the third patient with perinatal stroke resulted seizure free.We conclude that hemispherotomy can be performed successfully to treat medically intractable hemispheric epilepsy, providing remarkable results in terms of seizure outcome and quality of life.

Original languageEnglish
Pages (from-to)104-112
Number of pages9
JournalEpilepsy Research
Volume89
Issue number1
DOIs
Publication statusPublished - Mar 2010

Keywords

  • Functional hemispherotomy
  • Functional MR
  • Hemimegalencephaly
  • Hemispherectomy
  • Perinatal stroke
  • Rasmussen encephalitis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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