HEMISPHERECTOMY FOR INTRACTABLE SEIZURES IN CHILDREN - A REPORT OF 58CASES

Fifty-eight children who underwent anatomical, functional, or modified anatomical hemispherectomy for intractable seizures from 1986 to 1995 were evaluated for seizure control, motor function, and complications . Age at surgery ranged from 0.3 to 17.3 years (median 2.8 years). Twe nty-seven anatomical, 27 functional, and 4 modified anatomical hemisph erectomies were performed. Seizure control and motor function in the 5 0 patients with more than 1 year follow-up revealed a 90% or better re duction in seizure frequency in 44/50 (88%) overall: 19/22 (86%) anato mical, 23/26 (89%) functional, and 2/2 modified anatomical. Motor func tion of the preoperatively hemiparetic extremities was improved or unc hanged postoperatively in 38/50 (76%) of the patients. Complications i ncluded one intraoperative death, one late death from shunt obstructio n managed elsewhere, late postoperative seizure breakthrough requiring reoperation and further disconnection in 5/27 functional hemispherect omy patients, mild cerebrospinal fluid infections in 3/27 anatomical h emispherectomy patients, and hydrocephalus requiring shunting in 3/27 functional hemispherectomy patients. A review of the literature and co mparison of techniques is presented.