Staged Hemispherotomy in an Infant with Catastrophic Epilepsy without Hemiparesis
Alaa Eldin Elsharkawy and Ingrid Tuxhorn
World Journal of Surgical Research 2014, 3:7
Timing of hemispherotomy in young children with catastrophic epilepsy is a clinical challenge for the surgical and pediatric team.
a 4-year-old boy presented at age of 3.5 weeks with catastrophic right temporo-parieto-occipital epilepsy, without motor neurological deficit. Magnetic resonance imaging (MRI) showed right temporo-parieto-occipital focal cortical dysplasia (FCD). Video EEG monitoring was concordant for seizure onset with the MRI lesion.
The patient underwent temporo-parieto-occipital disconnection at 7 months of age, extended disconnection at 11 months and a multilobar resection at 14 months of age there was only temporary seizure reduction. Repeat presurgical evaluation at 20 months of age demonstrated more extensive dysplasia involving the right frontocentral regions. At age of 22 months the patient became seizure free after right hemispherotomy. Postoperatively he became alert and had restart of development but motor examination showed a moderate left hemiparesis.
this case demonstrates that an aggressive approach in infants with epileptic encephalopathy due to extensive FCD is warranted. Assessment of the risk/benefit ratio for hemispherotomy should be individualized and each patient must be assessed separately