B Pascher; T Pieper; S Kessler-Uberti; H Eitel; T Getzinger; T Hartlieb; M Staudt; I Bluemcke; M Kudernatsch; PA Winkler; D Kolodziejczyk; H Holthausen

doi:10.1055/s-0031-1274072

"Everything but motor (EBM)" – subtotal hemispherectomy sparing the primary sensori-motor region in children with hemispheric epilepsies but without hemiparesis

B Pascher ¹, T Pieper ¹, S Kessler-Uberti ¹, H Eitel ¹, T Getzinger ¹, T Hartlieb ¹, M Staudt ¹, I Bluemcke ², M Kudernatsch ³, PA Winkler ³, D Kolodziejczyk ³, H Holthausen ¹

¹Schön Klinik Vogtareuth, Neuropädiatrie, Vogtareuth, Germany
²Universität Erlangen, Neuropathologie, Erlangen, Germany
³Schön Klinik Vogtareuth, Neurochirurgie, Vogtareuth, Germany

Abstract

Rationale: It is well established that for hemiparetic children suffering from intractable focal epilepsy caused by a hemispheric pathology, hemispherotomy is for most patients the surgical option with the best chance for a good seizure outcome. In children without or with only a very mild hemiparesis, the decision to perform a hemispherotomy is extremely difficult. As an alternative surgical approach, we present the subtotal hemispherectomy sparing the primary sensori-motor region (EBM).

Methods: Retrospective evaluation of 24 patients (10 f/14m; average age at epilepsy onset 1y11m; at operation 8y6m) who underwent subtotal hemispherectomy sparing the primary sensori-motor region. Comparison between 2 groups concerning etiology, extent of resection, outcome and complications: Group 1 (G1): 13 patients, operations 1997–2003; Group 2 (G2): 11 patients, operations 2006–2010.

Results:

Etiology: focal cortical dysplasia: G1 69,3%; G2 54,5%, malformations of cortical development: G2 18,2%, phakomatosis: G1 15,3%; G2 9,1%, polymicrogyria: G1 7,7%; G2 18,2%, post-HSV-enceph: G1 7,7%.

Extend of resection: variations according to the results of the presurgical evaluation.

Seizure Outcome (Engel's classification): Class Ia: G1 30,8%; G2 63,6%, Class II: G1 7,7%; G2 9,1%, Class III: G1 46,2%; G2 9,1%, Class IV: G1 15,4%; G2 18,2%.

Complications: transient hemiparesis post OP: G1 7,7%; G2 18,2%, permanent hemiparesis post OP: G1 38,5%; G2 36,4%.

Conclusions: In children with hemispheric epilepsies but no hemiparesis, a subtotal hemispherectomy sparing the sensorimotor area (EBM) could be a valuable surgical option. Not surprising, this procedure includes a high risk of hemiparesis There is a tendency to better results in terms of seizure outcome comparing the recent to earlier series – most likely because of growing experience regarding selection criteria (ictal and interictal EEG, MRI etc) and surgical technique.