title: Disconnective surgery in posterior quadrantic epilepsy: experience in a consecutive series of 10 patients.
abstract: OBJECTIVE
  Outcomes following functional hemispherotomy in patients with drug-resistant epilepsy have been well described. However, studies reporting long-term longitudinal outcomes after subhemispheric disconnective epilepsy surgery are still limited.
  
  
  METHODS
  The authors conducted a retrospective review of prospectively collected data of 10 children who underwent temporoparietooccipital (TPO) disconnective surgery at the Vienna Pediatric Epilepsy Center.
  
  
  RESULTS
  There were 3 males and 7 females (median age 8.7 years; range 4.2-22.1 years). The affected hemisphere was the left in 3 patients and the right in 7. The patients' median age at seizure onset was 3.0 years (range 0.2-8.3 years). The median duration of epilepsy before surgery was 5.2 years (range 1.3-17.2 years). The underlying pathology was TPO malformation of cortical development in 5 patients, and venous infarction, posterior hemispheric quadrant atrophy, Sturge-Weber syndrome, cortical involvement of a systemic lupus erythematosus, and gliosis after cerebral tumor treatment in 1 each. In 6 children, a pure TPO disconnection was performed; in 2 patients, the temporal lobe was resected and parietooccipital disconnection was performed. The 2 remaining patients had had previous epilepsy surgery that was extended to a TPO disconnection: disconnection of the occipital lobe (n = 1) and resection of the temporal lobe (n = 1). The authors encountered no complications while performing surgery. No patient needed blood replacement therapy. No patient developed CSF disturbances that warranted treatment. Nine of 10 patients are currently seizure free since surgery (Wieser Class 1a) at a median follow-up time of 2.1 years (range 4 months to 8.1 years).
  
  
  CONCLUSIONS
  Temporoparietooccipital disconnection is a safe and effective motor-sparing epilepsy surgery in selected cases. Technical adjuncts facilitate a better intraoperative visualization and orientation, thereby enabling a less invasive approach than previously suggested.
authors.affiliation: Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Dorfer
authors.forename: Thomas
authors.initials: T
authors.lastname: Czech
authors.forename: Angelika
authors.initials: A
authors.lastname: Mühlebner-Fahrngruber
authors.forename: Aygül
authors.initials: A
authors.lastname: Mert
authors.forename: Gudrun
authors.initials: G
authors.lastname: Gröppel
authors.forename: Klaus
authors.initials: K
authors.lastname: Novak
authors.forename: Anastasia
authors.initials: A
authors.lastname: Dressler
authors.forename: Edith
authors.initials: E
authors.lastname: Reiter-Fink
authors.forename: Tatjana
authors.initials: T
authors.lastname: Traub-Weidinger
authors.forename: Martha
authors.initials: M
authors.lastname: Feucht
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D009778:Occipital Lobe / Q000601:surgery*; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult