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Fifty consecutive hemispherectomies: outcomes, evolution of technique, complications, and lessons learned. Neurosurgery 2014 Feb;74(2):182-94; discussion 195

Date

11/02/2013

Pubmed ID

24176954

Pubmed Central ID

PMC3916907

DOI

10.1227/NEU.0000000000000241

Scopus ID

2-s2.0-84893785676   30 Citations

Abstract

BACKGROUND: Techniques for achieving hemispheric disconnection in patients with epilepsy continue to evolve.

OBJECTIVE: To review the outcomes of the first 50 hemispherectomy surgeries performed by a single surgeon with an emphasis on outcomes, complications, and how these results led to changes in practice.

METHODS: The first 50 hemispherectomy cases performed by the lead author were identified from a prospectively maintained database. Patient demographics, surgical details, clinical outcomes, and complications were critically reviewed.

RESULTS: From 2004 to 2012, 50 patients underwent hemispherectomy surgery (mean follow-up time, 3.5 years). Modified lateral hemispherotomy became the preferred technique and was performed on 44 patients. Forty patients (80%) achieved complete seizure freedom (Engel I). Presurgical and postsurgical neuropsychological evaluations demonstrated cognitive stability. Two cases were performed for palliation only. Previous hemispherectomy surgery was associated with worsened seizure outcome (2 of 6 seizure free; P .005). The use of Avitene was associated with a higher incidence of postoperative hydrocephalus (56% vs 18%; P = .03). In modified lateral hemispherotomy patients without the use of Avitene, the incidence of hydrocephalus was 13%. Complications included infection (n = 3), incomplete disconnection requiring reoperation (n = 1), reversible ischemic neurological deficit (n = 1), and craniosynostosis (n = 1). There were no (unanticipated) permanent neurological deficits or deaths. Minor technique modifications were made in response to specific complications.

CONCLUSION: The modified lateral hemispherotomy is effective and safe for both initial and revision hemispherectomy surgery. Avitene use appears to result in a greater incidence of postoperative hydrocephalus.

Author List

Lew SM, Koop JI, Mueller WM, Matthews AE, Mallonee JC

Authors

Jennifer I. Koop Olsta PhD Professor in the Neurology department at Medical College of Wisconsin
Sean Lew MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin
Anne E. Matthews PAC Physician Assistant Surgical in the Neurosurgery department at Medical College of Wisconsin
Wade M. Mueller MD Professor in the Neurosurgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Brain
Child
Child, Preschool
Cognition Disorders
Follow-Up Studies
Functional Laterality
Hemispherectomy
Humans
Hydrocephalus
Infant
Magnetic Resonance Imaging
Neuropsychological Tests
Palliative Care
Prospective Studies
Seizures
Treatment Outcome
Young Adult