Hemispherotomy Technique Does Not Determine Seizure Outcome in Pediatric Drug-Resistant Epilepsy
Abstract number :
3.442
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2232974
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:29 AM
Authors :
Georgia Ramantani, MD, PhD – University Children`s Hospital Zurich; Christine Bulteau, MD, PhD – Pediatric Neurosurgery – Hospital Fondation Adolphe de Rothschild, Paris, France; Dorottya Cserpan, PhD – Neuropediatrics – University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland; Willem Otte, PhD – Child Neurology – UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands; Helen Cross, MD, PhD – Child Neurology – Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK; Georg Dorfmüller, MD, PhD – Pediatric Neurosurgery – Hospital Fondation Adolphe de Rothschild, Paris, France; Josef Zentner, MD – Neurosurgery – Medical Center, University of Freiburg, Freiburg, Germany; Martin Tisdall, MD – Neurosurgery – Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK; Kees Braun, MD, PhD – Department of Child Neurology – UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
This is a Late Breaking abstract
Rationale: We aimed to assess determinants of long-term seizure freedom following hemispheric surgery for pediatric drug-resistant epilepsy and, most importantly, to assess the importance of the vertical parasagittal vs. the lateral periinsular/perisylvian/transylvian technique in achieving long-term seizure freedom in these patients.
Methods: We retrospectively analyzed the seizure outcomes of 457 children and adolescents with drug-resistant epilepsy who underwent hemispheric surgery in five collaborating European epilepsy centers between 2000 and 2016. Patients underwent either vertical parasagittal hemispherotomy or lateral periinsular/perisylvian/transylvian hemispherotomy. We identified variables related to long-term seizure freedom through multivariable regression modelling with missing data imputation and optimal group matching, and further investigated the role of surgical technique by Bayes factor (BF) analysis.
Results:177 (39%) children underwent vertical and 280 (61%) lateral hemispherotomy. Overall, 344 (75%) children achieved seizure freedom at a mean follow-up of 5.1 years (range 1 to 17.1). We identified contralateral MRI findings (odds ratio (OR)=5.5, 95% confidence interval [CI]=2.7-11.1), prior resective surgery (OR=5.0, CI=1.8-14.0), left hemispherotomy (OR=2.3, CI=1.3-3.9), acquired etiology other than stroke (OR=4.4, CI=1.1-18.0), and hemimegalencephaly (OR=2.8, CI=1.1-7.3) as significant covariates of seizure recurrence. We found no significant impact of hemispherotomy technique on seizure outcome (p=0.09, BF=1.1), with comparable complication rates for different approaches (p=0.24).
Conclusions: Knowledge about independent determinants of seizure outcome following pediatric hemispherotomy will improve counceling of patients and families. In contrast to the findings of a previous study, we found no difference in seizure-freedom rates between vertical and horizontal surgical approaches when accounting for different patient variables between groups.
Funding: None
Surgery