Objectives: Refractory epilepsy is associated with progressive neurological and cognitive decline, and therefore necessitates aggressive treatment. In selected cases, radical surgical treatment – consisting of hemispheric white matter disconnection is indicated.
In the current presentation we describe our experience, surgical indications, as well as the long-term epilepsy and functional outcome.
Methods: We retrospectively reviewed all pediatric cases that underwent hemispheric disconnection in our institute since 2001.
Results: 14 children underwent hemispheric disconnection. Epilepsy etiology included Rasmussen encephalitis (5), neonatal stroke (2), cortical dysplasia (3), hemimegalencephally (1), traumatic brain injury (1), bilateral Sturge-Weber Syndrome (1), and aneurysmal related hematoma (1). Five underwent prior epilepsy-related surgeries. Six disconnections were performed on the right side, and 8 on the left. There was one complication (infection) with a good recovery. Epilepsy and functional outcomes were favorable in most patients.
Conclusions: Hemispheric disconnection is an extreme surgical procedure. However, when performed in the correct indication, is associated with a good clinical functional outcome.
