Comparison of the Real-World Effectiveness of Vertical Versus Lateral Functional Hemispherotomy Techniques for Pediatric Drug-Resistant Epilepsy
Abstract number :
3.32
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1826726
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Alexander Weil, MD, FRCSC, FACS - Centre Hospitalier Universitaire Sainte-Justine; Aria Fallah, MD, MS, FRCS – Pediatric Neurosurgeon, Neurosurgery, David Geffen School of Medicine at University of California Los Angeles; George Ibrahim, MD, PhD, FRCSC, FAANS – Pediatric Neurosurgeon, Division of Pediatric Neurosurgery, Sick Kids Toronto, University of Toronto; Olivia Kola, MSc – Researcher, Neurosurgery, David Geffen School of Medicine at University of California Los Angeles; Jia-Shu Chen, BS – Medical Student, Medicine, Warren Alpert Medical School of Brown University; Tristan Brunette-Clément, MD, MSc – Neurosurgery Resident, Neurosurgery, Centre Hospitalier Universitaire Sainte-Justine; HOPS Research Group – University of California, Los Angeles
Rationale: For pediatric epilepsy patients with multi-lobar or hemispheric epileptogenic lesions, hemispherotomy is generally favored over anatomic hemispherectomy due to lower risk for complications and possibly better seizure outcomes. However, no high-quality studies comparing the lateral and vertical hemispherotomy techniques exist.
The Hemispherectomy Outcome Prediction Scale (HOPS) identified predictors of seizure freedom following hemispheric surgeries. We performed a post-hoc analysis of HOPS comparing the vertical parasagittal and lateral peri-insular/peri-Sylvian hemispherotomy techniques with respect to long-term seizure freedom.
Methods: Using participants from the HOPS dataset undergoing vertical parasagittal, lateral peri-insular, or lateral peri-Sylvian hemispherotomy, we assessed and calculated differences in seizure freedom rates using the time-to-event and Kaplan-Meier survival methods.
Results: Data was collected for 672 participants across 23 centers. Of these, 72 (10.7%) underwent vertical parasagittal hemispherotomy and 600 (89.3%) underwent lateral peri-insular/peri-Sylvian hemispherotomy. At 10-year follow-up, 62.4% (95% CI=53.5-70.2%) of the entire cohort attained seizure freedom (Figure 1). Seizure freedom was 88.8% (95% CI=78.9-94.3%) at 1-year follow-up and persisted at 85.5% (95% CI=74.7-92.0%) across 5- and 10-year follow-up in the vertical subgroup, but decreased from 89.2% (95% CI=86.3-91.5%) to 72.1% (95% CI=66.9-76.7%) and then 57.2% (95% CI=46.6-66.4%) at 1-, 5-, and 10-year follow-up, respectively, in the lateral subgroup (Figure 2). Vertical hemispherotomy was also associated with more durable seizure-free progression (p=0.01) and patients undergoing a lateral hemispherotomy had shorter time-to-seizure recurrence (HR=2.56; 95% CI=1.08-6.04; p=0.03) and increased seizure recurrence odds (OR=3.67; 95% CI=1.05-12.86; p=0.04).
Conclusions: This study demonstrated greater durability of seizure freedom from the vertical hemispherotomy technique compared to lateral peri-insular/peri-Sylvian techniques.
Funding: Please list any funding that was received in support of this abstract.: None.
Surgery