[Lessons learnt from 101 hemispherotomies in children with symptomatic epilepsy. Part I: seizure outcome].

Autor:	Melikyan AG; Burdenko Neurosurgical Center, Moscow, Russia., Kozlova AB; Burdenko Neurosurgical Center, Moscow, Russia., Vlasov PA; Burdenko Neurosurgical Center, Moscow, Russia., Shishkina LV; Burdenko Neurosurgical Center, Moscow, Russia., Demin MO; Burdenko Neurosurgical Center, Moscow, Russia., Shults EI; Burdenko Neurosurgical Center, Moscow, Russia., Buklina SB; Pirogov Russian National Research Medical University, Moscow, Russia., Nagorskaya IA; Burdenko Neurosurgical Center, Moscow, Russia., Strunina YV; Burdenko Neurosurgical Center, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko [Zh Vopr Neirokhir Im N N Burdenko] 2021; Vol. 85 (5), pp. 15-21.
DOI:	10.17116/neiro20218505115
Abstrakt:	Objective: To evaluate variables that may predict the outcome after hemispherotomy basing on a retrospective study of a large consecutive pediatric cohort of patients from a single institution. Material and Methods: One hundred and one patients with refractory seizures and variable decline in development ( n =78) underwent hemispherotomy (med. age - 43 months, med. epilepsy history - 30 months). Developmental pathology was the anatomical substrate of disorder in 42 patients, while the infantile post-stroke scarring and gliosis was its origin in the majority of 43 cases with acquired etiology. The progressive pathology (the Rasmussen encephalitis, Sturge-Weber angiomatosis and tuberous sclerosis) was the etiology in 16 children. Left-sided hemisphere was impaired in 54 cases; some contralateral anatomical and potentially epileptogenic MRI-abnormalities were noted also in «healthy» hemisphere in ¼ of all cases. Eight patients needed second surgery to complete sectioning of undercut commissural fibers. FU is known in 91 patients (med. - 1.5 years) and 73 of them were free of seizures (80.2%), but only 30 of 40 patients with FU > 2 years were still SF (75%). All but one of re-do hemispherotomies were successful. AED-treatment was discontinued in 46 cases and tapered in other 27 patients. Up to 90% of kids demonstrated some improvement in behavior and cognition. Results and Conclusion: Developmental pathology, infantile spasms and younger age onset of seizures are negative predictors for achievement of SF-status ( p <0.05). Neither bilateral epileptic EEG-signs, nor MRI-abnormalities in «healthy» hemisphere had any relation to outcome, but focal seizure onset was associated positively with further SF-status ( p = 0.03). Kids with multiple lobe unilateral CD do somewhat worse than their counterparts with hemimegalencephaly and acquired etiology. Post-hemispherotomy hemiparesis (either new or worsening of already existed one) has no relation either to the age at surgery, or to the age onset ( p = 0.41). Children with left-sided lesions were less successful in every neurodevelopmental domain except maintaining expressive language. Patients with relapse or persisting seizures have good chances to become SF by re-doing hemispherotomy and should be evaluated for the possibly incomplete hemispheric isolation.
Databáze:	MEDLINE
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