Abstracts

Rationale: Disconnective surgeries are indicated for patients with intractable multilobar epileptic focuses to prevent superficial hemosiderosis. Vertical approach of hemispherectomy, so called the hemispherotomy is nowadays selected for such cases to reduce surgical insult, especially for little children. Therefore, we have to discuss not only the efficacy but also the complications of it and find a way to troubleshoot.Methods: We have 20 cases that were indicated the hemispherotomy for patients involving hemisphere from 2003 to 2014 at Juntendo University hospital, Tokyo, Japan. Our patients included 18 patients with Sturge-Weber syndrome, and 2 patients with cortical dysplasia involving hemisphere. Median age at the surgery was 11 month-old. We have carried out the Delalande’s approach with some modification. We evaluated the efficacy for seizure outcome and their complications.Results: The seizure free ratio of our series is 80%. The cause of non-seizure free outcome was incompleteness of disconnection in three cases, and having another epileptic focus in contralateral hemisphere in one case. Re-surgeries to complete the disconnection were indicated for these three cases and resulted seizure free. We had four cases of hydrocephalus after the hemispherotomy. We found obstruction of the foramen of Monro in three cases, and non-communicating subdural hydroma in two cases. We indicated VP shunt for the first case, and opening the foramen of Monro under surgical microscope in two cases, and communication a subdural capsule to a subarachnoid space in one case. Opening the obstruction is effective for post-surgical hydrocephalus without shunting. Other complications were occulomotor nerve palsy in one and contralateral chronic subdural hematoma in one.Conclusions: We have 80% of seizure free outcome in the hemispherotomy, and 20% of hydrocephalus complication. Obstruction of the foramen of Monro is a main cause of hydrocephalus. Opening the foramen of Monro is effective to recover the hydrocephalus without cerebrospinal fluid shunting.