title: Which is the most appropriate disconnection surgery for refractory epilepsy in childhood?
abstract: Children with unilobar or multilobar pathology issuing in refractory epilepsy are potential candidates for surgical treatment. Extensive surgery results in good seizure control, but it also increases the risk of neurological deficits as well as motor and mental problems. We reviewed the cases of 19 children with refractory epilepsy treated surgically at Osaka University Hospital. Four of the 19 patients underwent temporal disconnection, 2 underwent occipital lobectomy, 4 underwent temporoparietooccipital disconnection, 6 underwent functional hemispherotomy, and 3 underwent corpus callosotomy. A good surgical outcome, i.e., Engel's class I or II, was achieved in 12 (63%) of the 19 patients. Excellent surgical outcomes and satisfactory motor and mental development were achieved in 4 patients who underwent temporoparietooccipital disconnection. The outcomes of functional hemispherectomy were also satisfactory. The outcomes of temporal disconnection and corpus callosotomy were poor in comparison to outcomes of the other procedures. We believe that better surgical outcomes would have been achieved with temporoparietooccipital disconnection in some cases treated by temporal disconnection or occipital resection. Adequate extensive surgical procedures should be considered for refractory childhood epilepsy arising from unilobar or multilobar pathology.
authors.affiliation: Department of Neurosurgery, Osaka University Graduate School of Medicine.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kishima
authors.forename: Satoru
authors.initials: S
authors.lastname: Oshino
authors.forename: Naoki
authors.initials: N
authors.lastname: Tani
authors.forename: Yomoyuki
authors.initials: Y
authors.lastname: Maruo
authors.forename: Shayne
authors.initials: S
authors.lastname: Morris
authors.forename: Hui Ming
authors.initials: HM
authors.lastname: Khoo
authors.forename: Takufumi
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Kuriko
authors.initials: K
authors.lastname: Shimono
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okinaga
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hirata
authors.forename: Amami
authors.initials: A
authors.lastname: Kato
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use; D001925:Brain Damage, Chronic / Q000209:etiology / Q000517:prevention & control; D002540:Cerebral Cortex / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003337:Corpus Callosum / Q000601:surgery; D004351:Drug Resistance; D004827:Epilepsy / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants