Hemispherotomy In The First Year Of Life: Safety, Feasibility, Complications and Seizure outcome – A Single-center Experience
Abstract number :
2.393
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2025
Submission ID :
818
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Mikolaj Pielas, MD – The Children's Memorial Health Institute
Katarzyna Kotulska, MD, PhD – The Children's Memorial Health Institute
Marcin Roszkowski, MD, PhD – The Children's Memorial Health Institute
Paweł Kowalczyk, MD, PhD – The Children's Memorial Health Institute
Rationale: Hemispheric procedures in epilepsy surgery pose a substantial challenge in young patients with low body weight and blood volume. This study aims to evaluate the safety, complications and seizure outcome of hemispherotomies performed in children under 12 months.
Methods: A retrospective analysis was conducted of patients under 12 months who underwent hemispherotomy between 2005 and 2024 at a national referral center for epilepsy surgery. Data collected included demographics, medical history, seizure onset age, age at surgery, duration of surgery, intubation and intensive care recovery time, blood product requirements, and perioperative and long-term complications. Seizure outcome was measured using the Engel score.
Results: Fifteen infants (7 males, 8 females) with a diagnosis of hemimegalencephaly (13) or extensive focal cortical dysplasia (2) were included, only one patient had an additional contralateral abnormality on MRI. The median seizure onset was 3 days, all children presented with daily seizures. The mean age at surgery was 7±2.68 months and body weight ranged from 6700g to 9800g. The average procedure time was 229±45 minutes with mean intraoperative blood transfusion volume of 412±318 ml; 87% of patients required average postoperative transfusion of 171ml (range 50-880ml). The patients stayed in intensive care unit for average 4,3±3,6 days with a mean intubation duration of 3.2 days.
There were no mortalities in the group studied, major complications included extensive intracerebral bleeding (2) and cardiac arrest during surgery (1). Other frequent adverse events were: 40% of patients required prolonged cardio-pulmonary support, 33% underwent shunt implementation due to postoperative hydrocephalus. One third of children experienced electrolytes disbalance and 4/15 had postoperative fever. Engel class I at 12 months follow-up was achieved in 54.5% of patients.
Conclusions: Hemispherotomy in first year of life is a feasible, yet demanding procedure with a significant risk of perioperative complication. A multidisciplinary approach is essential for optimal patient outcomes.
Funding: None
Surgery