ULTRASOUND-TAILORED FUNCTIONAL HEMISPHERECTOMY FOR SURGICAL CONTROL OF SEIZURES IN CHILDREN

Functional hemispherectomy techniques have been designed to minimize t he long-term complications of anatomical resection without reducing th e effectiveness of seizure control. The authors have used an ultrasoun d guided approach tailored to combine temporal lobectomy with frontal and occipital disconnections with a central topectomy of the lateral, insular, and interhemispheric cortex. This technique achieves a compre hensive functional disconnection and minimizes entrance and manipulati on within the body of the lateral ventricle. Fight patients ranging in age from 10 months to 23 years with congenital paresis and medically intractable seizures underwent functional hemispherectomy via this tec hnique. The average surgical time was 4.5 hours, and blood loss ranged from 90 to 400 mi. All but one patient was discharged after 5 days. P ostoperative fever syndromes, aseptic meningitis, and infection were a voided. On long-term follow-up evaluation (range 18-60 months, mean 38 months), seven of eight patients remain seizure free and were not on a course of anticonvulsant agents. Advantages of this technique includ e avoiding entrance into the ventricle, a more predictable postoperati ve period, and reduced postoperative complications.