Affiliation:
1. Departments of Neurology and
2. Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; and
3. Department of Neurology, University of Colorado, Denver, Colorado
Abstract
OBJECTIVEHemispherectomy is a surgical technique that is established as a standard treatment in appropriately selected patients with drug-resistant epilepsy. It has proven to be successful in pediatric patients with unilateral hemispheric lesions but is underutilized in adults. This study retrospectively evaluated the clinical outcomes after hemispherectomy in adult patients with refractory epilepsy.METHODSThis study examined 6 cases of hemispherectomy in adult patients at Barrow Neurological Institute. In addition, all case series of hemispherectomy in adult patients were identified through a literature review using MEDLINE and PubMed. Case series of patients older than 18 years were included; reports of patients without clear follow-up duration or method of validated seizure outcome quantification were excluded. Seizure outcome was based on the Engel classification.RESULTSA total of 90 cases of adult hemispherectomy were identified, including 6 newly added by Barrow Neurological Institute. Sixty-five patients underwent functional hemispherectomy; 25 patients had anatomical hemispherectomy. Length of follow-up ranged from 9 to 456 months. Seizure freedom was achieved in 80% of patients. The overall morbidity rate was low, with 9 patients (10%) having new or additional postoperative speech or language dysfunction, and 19 patients (21%) reporting some worsening of hemiparesis. No patients lost ambulatory or significant functional ability, and 2 patients had objective ambulatory improvement. Among the 41 patients who underwent additional formal neuropsychological testing postoperatively, overall stability or improvement was seen.CONCLUSIONSHemispherectomy is a valuable surgical tool for properly selected adult patients with pre-existing hemiparesis and intractable epilepsy. In published cases, as well as in this series, the procedure has overall been well tolerated without significant morbidity, and the majority of patients have been rendered free of seizures.
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Subject
Genetics,Animal Science and Zoology
Reference52 articles.
1. Long-term outcome of hemispheric surgery at different ages in 61 epilepsy patients;Althausen;J Neurol Neurosurg Psychiatry,2013
2. [Successful functional hemispherectomy in adult patients with refractory epilepsy.];de Francisco;Neurologia,2009
3. Aphasia after hemispherectomy in an adult with early onset epilepsy and hemiplegia;Loddenkemper;J Neurol Neurosurg Psychiatry,2004
4. [Successful functional hemispherectomy in adult patients with refractory epilepsy.];de Francisco;Neurologia,2009
5. Functional hemispherectomy in adults with intractable epilepsy syndromes: a report of 4 cases;Steinhoff;Epileptic Disord,2009
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