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Hemispherectomy for intractable seizures in children: a report of 58 cases

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Abstract

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). Twenty-seven anatomical, 27 functional, and 4 modified anatomical hemispherectomies were performed. Seizure control and motor function in the 50 patients with more than 1 year follow-up revealed a 90% or better reduction in seizure frequency in 44/50 (88%) overall: 19/22 (86%) anatomical, 23/26 (89%) functional, and 2/2 modified anatomical. Motor function of the preoperatively hemiparetic extremities was improved or unchanged postoperatively in 38/50 (76%) of the patients. Complications included one intraoperative death, one late death from shunt obstruction managed elsewhere, late postoperative seizure breakthrough requiring reoperation and further disconnection in 5/27 functional hemispherectomy patients, mild cerebrospinal fluid infections in 3/27 anatomical hemispherectomy patients, and hydrocephalus requiring shunting in 3/27 functional hemispherectomy patients. A review of the literature and comparison of techniques is presented.

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Author information

Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, UCLA Medical Center, Box 95 70 39, 90095-7039, Los Angeles, CA, USA

    Warwick J. Peacock & Monica C. Wehby-Grant

  2. Department of Pediatric Neurology, UCLA Medical Center, 90095, Los Angeles, CA, USA

    W. Donald Shields, D. Alan Shewmon & Raman Sankar

  3. Department of Pediatrics, Children's Hospital of Michigan at Detroit, 3901 Beaubien, 48201, Detroit, MI, USA

    Harry T. Chugani

  4. Department of Pathology and Laboratory Medicine (Neuropathology), UCLA Medical Center, 90095, Los Angeles, CA, USA

    Harry V. Vinters

  5. the Brain Research Institute, UCLA Medical Center, 90095, Los Angeles, CA, USA

    Harry V. Vinters

Authors
  1. Warwick J. Peacock
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  2. Monica C. Wehby-Grant
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  3. W. Donald Shields
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  4. D. Alan Shewmon
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  5. Harry T. Chugani
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  6. Raman Sankar
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  7. Harry V. Vinters
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Peacock, W.J., Wehby-Grant, M.C., Shields, W.D. et al. Hemispherectomy for intractable seizures in children: a report of 58 cases. Child's Nerv Syst 12, 376–384 (1996). https://doi.org/10.1007/BF00395089

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  • DOI: https://doi.org/10.1007/BF00395089

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