A vertical parasagittal approach to hemispherotomy was associated with more durable seizure freedom over 10 years compared with lateral approaches in pediatric drug-resistant epilepsy patients from the real-world Hemispheric Surgery Outcome Prediction Scale (HOPS) study.
Why this matters
In some pediatric patients, epileptogenic lesions are multi-lobar or hemispheric, resulting in a 40% rate of drug resistance. Surgical techniques involving disconnection or removal of the epileptic hemisphere can achieve excellent results in these patients.
Anatomic hemispherectomy is associated with excellent seizure freedom rates; however, hemispherotomy, which seeks to preserve brain tissue, is now the generally preferred approach, believed to reduce risk of complications and possibly achieve improved seizure outcomes.
Several different hemispherotomy techniques have emerged including a vertical parasagittal approach and a lateral peri-insular/peri-Sylvian approach. It remains unclear how the different techniques compare in terms of seizure outcome.