Our experience with pediatric epilepsy surgery focusing on corpus callosotomy and hemispherotomy.
OBJECTIVE
In pediatric patients with intractable epilepsy, surgical intervention should be considered in terms of seizure control and prevention of neuronal deterioration. We present our experience with pediatric epilepsy surgery, focusing on corpus callosotomy and hemispherotomy.


METHODS
A total of 257 pediatric patients underwent epilepsy surgeries during the last decade in our clinic. The two most common surgical procedures were corpus callosotomy and hemispherotomy. The surgical outcomes of the patients undergoing these operations were analyzed with regard to seizure outcomes and surgical complications.


RESULTS
Corpus callosotomy proved to be extremely effective in controlling drop attacks, especially when the callosum was totally sectioned. Postoperative improvement of psychomotor function also was noticeable in >70% of the cases. In patients who underwent hemispherotomy, the etiology of unilateral hemispheric lesions was closely related to surgical results, with cases of hemimegalencephaly having the worst seizure outcome and most frequent surgical complications. Incomplete section of the callosum, one of the most important causes of residual seizures, was found in three cases.


CONCLUSIONS
In pediatric epilepsy surgery, corpus callosotomy is very effective in abolishing drop attacks and improving postoperative psychomotor function. For hemispherotomy, cases of hemimegalencephaly had the worst seizure control and surgical complications. Incomplete section of the corpus callosum should be carefully evaluated as a cause of surgical failure.
Shimizu
Hiroyuki
H
Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan. smzh@tmnh.fuchu.tokyo.jp
D000293:Adolescent; D000367:Age Factors; D001921:Brain / Q000002:abnormalities / Q000601:surgery; D002540:Cerebral Cortex / Q000002:abnormalities / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003337:Corpus Callosum / Q000601:surgery*; D004827:Epilepsy / Q000523:psychology / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011597:Psychomotor Performance; D013575:Syncope / Q000517:prevention & control / Q000601:surgery; D016896:Treatment Outcome