Why would you remove half a brain? The outcome of 58 children after hemispherectomy - The Johns Hopkins Experience 1968 to 1996

Purpose. The report the outcomes of the 58 hemispherectomies performed at John Hopkins between 1968 and January 1996. Methods. Charts were reviewed of the 58 hemispherectomies performed at Johns Hopkins Medical Institutions by the Pediatric Epilepsy Group during ttthe years 1968 to 1996. Twenty- seven operations ere done for Rasmussen's syndrome, 24-operations for cortical dysplasias/hemimegalenophalies, and 7 for Sturge-Welber syndrome or other congenital vascular problems. Seizure outcomes of the procedure. Therefore, a score was constructed that included seizure frequency, motor disability, and intellectual handicap. This burden of illness score better described the child's handicap before and after surgery. Results. Perioperative death occurred in 4 out of 58 children. Of the 54 surviving children, 54% (29/54) are seizure-sfree 24% (3/54) have nonhandicapping seizures, and 23% (12/54) have residual seizures that interfere to some extent wtih function. Reduction in seizures was related to the etioogy of the unilateral epilepsy. Eighty-nine percent of children with Rasmussen's 67% of those with dysplasias, and 67% of the vascular group are seizure-free, or have occasional, nonhadicapping seizures. All operations were considered by the parents and the physicians to have been successful in decreasing the burden of illness. In 44 the procedure was very successful, in 7 it was moderately successful, and in 3 it was minimally successful. Success was related to the etiology, and early surgeryt was preferable. Conclusion. Hemispherectomy can be valuable procedure for relieving the burden of seizures, the burden of medication, and the general dysfunction in children with evere or progressive unilateral cortical disease. Early hemispherectomy, although increasing the hemiparesis in children with Rasmussen's syndrome, relieves the burden of constant seizures and allows the child to return to a more normal life. In children with dysplasias, early surgery can allow the resumption of more normal development.