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Functional hemispherectomy for catastrophic epilepsy in very young infants: technical considerations and complication avoidance

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Abstract

Purpose

We report on our experience in performing peri-insular functional hemispherectomy (PIH) in very young infants with catastrophic epilepsy.

Methods

We retrospectively reviewed the medical charts of all infants with catastrophic epilepsy that underwent PIH under the age of 4 months at our institution.

Results

Four infants (three female, one male) were included (median age at time of surgery 2.9 months, range from 2.4 to 4.2 months; median patient’s weight at time of surgery 5650 g, range from 4300 to 7500 g). None of the patients experienced hemodynamic instability during surgery. All four patients were given red blood cell replacement (median 435 ml, range from 230 to 800 ml), three of the four patients experienced coagulopathy during surgery and were given platelet cells transfusion in one (50 ml) and fresh frozen plasma in two patients (191 and 320 ml). Two patients experienced severe complications that, however, did not cause a permanent morbidity due to prompt diagnosis and correct management. After a median follow-up time of 4.3 years (range from 1.3 to 7.9 years), three of four patients are completely seizure free. The remaining patient is experiencing brief daily staring episodes. All of them have a hemiparesis but are fully ambulatory and have a useful upper limb function.

Conclusion

In catastrophic epilepsy, PIH within the first months of life is feasible provided that an experienced multidisciplinary team is involved. Awareness of surgical challenges and potential complications is indispensible when the life-threatening nature of the epilepsy compels neurosurgeons to operate at this very young age.

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Conflict of interest

The authors report no conflict of interest.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, The Hospital for Sick Children, Suite 1503, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada

    Christian Dorfer & James T. Rutka

  2. Division of Pediatric Neurology, The Hospital for Sick Children, Toronto, ON, Canada

    Ayako Ochi & Elizabeth Donner

  3. Division of Neuroradiology, The Hospital for Sick Children, Toronto, ON, Canada

    O. Carter Snead III, Stephanie Holowka & Elysa Widjaja

  4. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Christian Dorfer, Ayako Ochi, O. Carter Snead III, Elizabeth Donner, Stephanie Holowka, Elysa Widjaja & James T. Rutka

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  1. Christian Dorfer
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  2. Ayako Ochi
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  3. O. Carter Snead III
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  7. James T. Rutka
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Correspondence to James T. Rutka.

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Dorfer, C., Ochi, A., Snead, O.C. et al. Functional hemispherectomy for catastrophic epilepsy in very young infants: technical considerations and complication avoidance. Childs Nerv Syst 31, 2103–2109 (2015). https://doi.org/10.1007/s00381-015-2794-3

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  • DOI: https://doi.org/10.1007/s00381-015-2794-3

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