Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Surgical Results of Functional Hemispherectomy and Peri-insular Hemispherotomy

난치성 간질에 대한 기능적 대뇌반구 절제술 및 Peri-insular 대뇌반구 절제술의 효과

  • Lee, Dong Kul (Department of Neurosurgery, Ulsan University College of Medicine, Asan Medical Center) ;
  • Lee, Wan Su (Department of Neurosurgery, Ulsan University College of Medicine, Asan Medical Center) ;
  • Lee, Jung Kyo (Department of Neurosurgery, Ulsan University College of Medicine, Asan Medical Center) ;
  • Kim, Chung Ho (Department of Pediatrics, Ulsan University College of Medicine, Asan Medical Center) ;
  • Ko, Tae Seong (Department of Pediatrics, Ulsan University College of Medicine, Asan Medical Center) ;
  • Lee, Sang Am (Department of Neurology, Ulsan University College of Medicine, Asan Medical Center)
  • 이동걸 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 이완수 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 이정교 (울산대학교 의과대학 서울중앙병원 신경외과학교실) ;
  • 김정호 (울산대학교 의과대학 서울중앙병원 소아과학교실) ;
  • 고태성 (울산대학교 의과대학 서울중앙병원 소아과학교실) ;
  • 이상암 (울산대학교 의과대학 서울중앙병원 신경과학교실)
  • Received : 1999.12.27
  • Accepted : 2000.07.03
  • Published : 2000.09.28
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Abstract

Objective : To confirm the efficacy of functional hemispherectomy and peri-insular hemispherotomy on treatment of intractable epilepsy. Materials & Methods : From April 1997 to February 1999, we performed 1 functional hemispherectomy and 6 peri-insular hemispherotomy in 7 consecutive patients. These procedures result in completely disconnected hemisphere while maintaining the disconnected portion of the hemisphere intact within the surgical cavity. The indications were hemimegalencephaly in 2 cases, infarction with encephalomalacia in 2, Sturge-Weber syndrome in 1, hemiconvulsion hemiplegia epilepsy syndrome in 1, cortical dysplasia with leptomeningeal cyst in 1. Mean follow-up is 15.8 months(range 8-28 months). Results : Among 7 patients, 1 patient died immediately after peri-insular hemispherotomy. Five patients became seizure free with reduced doses of medications. One patient developed rare disabling seizure with medication. In 6 patients, there were improvements in the function of the hemiparetic limbs in the postoperative phase. A 3-year-old boy with infarction and encephalomalacia died few hours after surgery due to postoperative hypothermia. Two patients required shunt after surgery. Two patients developed postoperative brain swelling but were successfully managed with conservative care. Conclusion : In conclusion, functional hemispherectomy and peri-insular hemispherotomy may provide substantial seizure control in selected cases of young hemiplegic patients with intractable epilepsy.

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