J Neurosurg Pediatr. 2025 Nov 21:1-9. doi: 10.3171/2025.7.PEDS2577. Online ahead of print.
ABSTRACT
OBJECTIVE: Hemispherotomy and posterior quadrant disconnection (PQD) are standard surgical treatments for medically intractable epilepsy in pediatric patients. However, the current academic literature is limited on their efficacy and safety in very young patients. This study evaluates the outcomes of patients ≤ 12 months of age who underwent hemispherotomy or PQD.
METHODS: The authors retrospectively reviewed the medical records of patients ≤ 12 months of age who underwent epilepsy surgery at Washington University and St. Louis Children’s Hospital from 2003 to 2023. Data on diagnosis, age at surgery, operative details, hospital length of stay, and complications were reported. The Engel classification and Gross Motor Function Classification System (GMFCS) were used to assess seizure and motor outcomes, respectively.
RESULTS: A total of 14 patients who underwent either hemispherotomy (n = 12) or PQD (n = 2) were included. Overall, 57% had a diagnosis of hemimegaloencephaly, 29% had middle cerebral artery infarcts, and 14% had cortical development malformation. The mean age at surgery was 6 months, with the youngest child being 2 months of age. The mean estimated blood loss was 58% of the total blood volume. The mean duration of follow-up was 4.8 years. At 1 year postoperatively, seizure freedom was 75%. At the last follow-up, 54% of patients were free of disabling seizures (Engel class I), with 57% of this subgroup being completely seizure free (Engel class IA). Of the remaining patients, 23% experienced rare disabling seizures (Engel class II) and 23% experienced worthwhile improvement (Engel class III). At the last follow-up, 67% of patients had a GMFCS level of I or II (walking with no or some limitations) and 33% had a GMFCS level of IV (assisted self-mobility). There were no deaths or long-term postoperative complications.
CONCLUSIONS: Hemispherotomy and PQD in children ≤ 12 months of age are associated with meaningful seizure control and improved motor outcomes. These procedures should be considered for the treatment of medically refractory epilepsy, even in very young infants.
PMID:41270278 | DOI:10.3171/2025.7.PEDS2577
