PERI-OPERATIVE AND POST-SURGERY DIFFERENCES BY PATHOLOGY IN PEDIATRIC CEREBRAL HEMISPHERECTOMY PATIENTS
Abstract number :
2.453
Submission category :
Year :
2003
Submission ID :
2264
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Gary W. Mathern, Snow Nguyen, Rinat Jonas, Robert Asarnow, Susie Curtiss, Stella de Boda Univeristy of California,Los Angeles, David Geffen School of Medicine, Los Angeles, CA
The goal of this study was to compare peri-operative and post-surgery differences by pathological substrate in cerebral hemispherectomy patients from a single pediatric epilepsy surgery program. The second goal was to determine if seizure duration and seizure control affected post-surgery development quotients.
Cerebral hemispherectomy cases at UCLA (n=115) were catalogued by pathology into those with hemimegalencephaly (HM; n=16), hemispheric cortical dysplasia (hemi CD; n=39), infarct/ischemia (n=27), Rasmussen[rsquo]s encephalitis (n=21), and Other (n=12). Medical records were reviewed for peri-operative variables along with post-surgery seizure control, Vineland Adaptive Developmental Quotients (DQ), and Spoken Language Rank (SLR) assessments.
HM and hemi CD were the youngest at surgery and had the highest incidence of infantile spasms pre-surgery. Surgically, HM had the greatest blood loss and longest surgery time along with the most complications. Numerically, fewer HM cases were seizure free or not taking AEDs 1-5 years post-surgery, but the differences were not statistically significant. Assessments on average 6 years post-surgery showed than HM had poorer spoken language and motor scores in the paretic limb compared with the other pathology groups. More importantly, post-surgery Vineland DQs negatively correlated with seizure duration and post-surgery seizure control in all pathology groups. In other words, patients with the best post-surgery Vineland DQs were those who had a pre-surgery seizure duration of less than 2-3 years and complete seizure control post-surgery.
There are pre- and post-surgery differences in pediatric cerebral hemispherectomy patients that vary by pathology that affect operative planning and post-surgery neurological development. Hemimegalencephaly cases have greater problems than other pathologies. Equally important is that regardless of pathology, shorter duration of seizures (under 2-3 years) and seizure control are associated with the best post-surgery developmental quotients in pediatric hemispherectomy patients.
[Supported by: RO1 NS38992. ]