Long-Term Outcomes of Hemispheric Disconnection in Pediatric Patients with Intractable Epilepsy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose Hemispherectomy reportedly produces remarkable results interms of seizure outcome and quality of life for medically intractable hemispheric epilepsy inchildren. We reviewed the neuroradiologic findings, pathologic findings, epilepsy characteristics, and clinical long-term outcomes in pediatric patients following a hemispheric disconnection. Methods We retrospectively studied 12 children (8 males) who underwent a hemispherectomy at Asan Medical Center between 1997 and 2005. Clinical, EEG, neuroradiological, and surgical data were collected. Long-term outcomes for seizure, motor functions, and cognitivefunctions were evaluated at a mean follow-up of 12.7 years (range, 7.6–16.2 years) after surgery. Results The mean age at epilepsy onset was 3.0 years (range, 0–7.6 years). The followingepilepsy syndromes were identified in our cohort: focal symptomatic epilepsy (n=8), West syndrome (n=3), and Rasmussen’s syndrome (n=1). Postoperative histopathology of our study patients revealed malformation of cortical development (n=7), encephalomalacia as a sequela ofinfarction or trauma (n=3), Sturge-Weber syndrome (n=1), and Rasmussen’s encephalitis (n=1). The mean age at surgery was 6.5 years (range, 0.8–12.3 years). Anatomical or functional hemispherectomy was performed in 8 patients, and hemispherotomy was performed in 4 patients. Eight of our 12 children (66.7%) were seizure-free, but 3 patients with perioperative complications showed persistent seizure. Although all patients had preoperative hemiparesis and developmental delay, none had additional motor or cognitive deficits after surgery, and most achievedindependent walking and improvement in daily activities. Conclusions The long-term clinical outcomes of hemispherectomy in children with intractable hemispheric epilepsy are good when careful patient selection and skilled surgical approaches are applied.
Abstract
Background and Purpose Hemispherectomy reportedly produces remarkable results interms of seizure outcome and quality of life for medically intractable hemispheric epilepsy inchildren. We reviewed the neuroradiologic findings, pathologic findings, epilepsy characteristics, and clinical long-term outcomes in pediatric patients following a hemispheric disconnection. Methods We retrospectively studied 12 children (8 males) who underwent a hemispherectomy at Asan Medical Center between 1997 and 2005. Clinical, EEG, neuroradiological, and surgical data were collected. Long-term outcomes for seizure, motor functions, and cognitivefunctions were evaluated at a mean follow-up of 12.7 years (range, 7.6–16.2 years) after surgery. Results The mean age at epilepsy onset was 3.0 years (range, 0–7.6 years). The followingepilepsy syndromes were identified in our cohort: focal symptomatic epilepsy (n=8), West syndrome (n=3), and Rasmussen’s syndrome (n=1). Postoperative histopathology of our study patients revealed malformation of cortical development (n=7), encephalomalacia as a sequela ofinfarction or trauma (n=3), Sturge-Weber syndrome (n=1), and Rasmussen’s encephalitis (n=1). The mean age at surgery was 6.5 years (range, 0.8–12.3 years). Anatomical or functional hemispherectomy was performed in 8 patients, and hemispherotomy was performed in 4 patients. Eight of our 12 children (66.7%) were seizure-free, but 3 patients with perioperative complications showed persistent seizure. Although all patients had preoperative hemiparesis and developmental delay, none had additional motor or cognitive deficits after surgery, and most achievedindependent walking and improvement in daily activities. Conclusions The long-term clinical outcomes of hemispherectomy in children with intractable hemispheric epilepsy are good when careful patient selection and skilled surgical approaches are applied.
참고문헌 (23)
- McKenzie KG, "The present status of a patient who had the right cerebral hemisphere removed", J Am Med Assoc, 111, pp.168~183 (1938)
- Krynauw RA, "Infantile hemiplegia treated by removing one cerebral hemisphere", J Neurol Neurosurg Psychiatry, 13, pp.243~267 (1950)
- White HH, "Cerebral hemispherectomy in the treatment of infantile hemiplegia; review of the literature and report of two cases", Confin Neurol, 21, pp.1~50 (1961)
- Wilson PJ, "Cerebral hemispherectomy for infantile hemiplegia. A report of 50 cases", Brain, 93, pp.147~180 (1970)
- Bulteau C, "Epilepsy surgery for hemispheric syndromes in infants: hemimegalencepahly and hemispheric cortical dysplasia", Brain Dev, 35, pp.742~747 (2013)
- Rasmussen T, "Hemispherectomy for seizures revisited", Can J Neurol Sci, 10, pp.71~78 (1983)
- Delalande O, "Vertical parasagittal hemispherotomy: surgical procedures and clinical long-term outcomes in a population of 83 children", Neurosurgery, 60(2 Suppl 1), pp.ONS19~ONS32 (2007)
- Villemure JG, "Peri-insular hemispherotomy: surgical principles and anatomy.", Neurosurgery, 37, pp.975~981 (1995)
- Schramm J, "Transsylvian keyhole functional hemispherectomy", Neurosurgery, 49, pp.891~900 (2001)
- Shimizu H, "Modification of peri-insular hemispherotomy and surgical results", Neurosurgery, 47, pp.367~372 (2000)
- Devlin AM, "Clinical outcomes of hemispherectomy for epilepsy in childhood and adolescence", Brain, 126(Pt 3), pp.556~566 (2003)
- Boshuisen K, "Contralateral MRI abnormalities affect seizure and cognitive outcome after hemispherectomy", Neurology, 75, pp.1623~1630 (2010)
- Moosa AN, "Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children", Neurology, 80, pp.253~260 (2013)
- Kossoff EH, "Hemispherectomy for intractable unihemispheric epilepsy etiology vs outcome", Neurology, 61, pp.887~890 (2003)
- Schramm J, "Pediatric functional hemispherectomy: outcome in 92 patients", Acta Neurochir (Wien), 154, pp.2017~2028 (2012)
- Villarejo-Ortega F, "Seizure and developmental outcomes after hemispherectomy in children and adolescents with intractable epilepsy", Childs Nerv Syst, 29, pp.475~488 (2013)
- Jonas R, "Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes", Neurology, 62, pp.1712~1721 (2004)
- Ciliberto MA, "Palliative hemispherotomy in children with bilateral seizure onset", J Neurosurg Pediatr, 9, pp.381~388 (2012)
- Wyllie E, "Successful surgery for epilepsy due to early brain lesions despite generalized EEG findings", Neurology, 69, pp.389~397 (2007)
- Hallbook T, "Contralateral MRI abnormalities in candidates for hemispherectomy for refractory epilepsy", Epilepsia, 51, pp.556~563 (2010)
- Pulsifer MB, "The cognitive outcome of hemispherectomy in 71 children", Epilepsia, 45, pp.243~254 (2004)
- Ramantani G, "Seizure control and developmental trajectories after hemispherotomy for refractory epilepsy in childhood and adolescence", Epilepsia, 54, pp.1046~1055 (2013)
- Smith JR, "Hemispherotomy: description of surgical technique", Childs Nerv Syst, 21, pp.466~472 (2005)