Seizure freedom with differing hemispherotomy techniques for drug-resistant pediatric epilepsy

Takeaway

  • 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.