Hemispherectomy in treatment of seizures: current perspectives of the indications, techniques and complications: literature review

Introducción: A hemisferectomía es un procedimiento valioso en el tratamiento de trastornos convulsivos causados por desordenes hemisféricos unilaterales. El hemisferectomía anatómica se ha utilizado para este fin desde 1938, sin embargo, se abandonó este procedimiento después de informes de complicaciones postoperatorias causadas por hemosiderosis superficial, ependimitis e hidrocefalia obstructiva. Así que, se ha mostrado en la literatura modificaciones en las indicaciones y técnicas de hemisferectomía anatómica cuya finalidad es la de reducir la incidencia de esta complicación sin dejar de lograr control de las convulsiones. Sobre la base de la literatura, la hemisferectomía mejora la calidad de vida de los pacientes que tiene la indicación para realizar este procedimiento, ya que permite reducir la frecuencia de las convulsiones, si tónica o átona, tónico-clónicas Objetivo: El objetivo de esta revisión de la literatura es discutir los detalles técnicos, modalidades, riesgos, complicaciones, resultados y de pronóstico de hemisferectomía basado en la revisión crítica de la literatura. Casuística y Métodos: Se realizó la consulta bibliográfica, utilizando la base de datos MEDLINE, LILACS, SciELO, que utiliza el lenguaje como criterios de selección, la elección de los artículos recientes preferiblemente en portugués, español o inglés. Conclusión: Según las referencias, hemisferectomía es un procedimiento con buen resultado para las personas con convulsiones derivadas cuando está indicado para casos seleccionados y la tasa de éxito no es proporcional a la extensión de la resección del tejido neuronal. A mayor resección puede o no reducir la frecuencia de las crisis, sin embargo, la incidencia de la morbilidad puede ser mayor.

Background: The hemispherectomy is a valuable procedure in the management of seizure disorders caused by unilateral hemispheric disease. The anatomical hemispherectomy has been used for this purpose since 1938, however, it was abandoned after reports of postoperative complications caused by superficial hemosiderosis, ependymitis and obstructive hydrocephalus. So that, it has been showed modifications in the techniques of hemispherectomy whose the purpose is reduce the incidence of this complications while still achieving seizure control. Based on literature, the hemispherectomy improves the quality of life of patients that has the indication to perform this procedure because it allows reducing the frequency of seizures, whether tonic or atonic, tonic-clonic. Aim: The aim of this literature review is discuss the indications, technical details, modalities, risks, complications, results as well de prognosis of callosotomy based on critical literature review and the authors experience. Casuistry and Methods: It was performed bibliographical consultation, using the databases MEDLINE, LILACS, SciELO, utilizing language as selection criteria, choosing preferably recent articles in Portuguese, Spanish or English. Conclusion: According to references, the functional hemispherectomy has a good outocome for those with seizures arisin when indicated to selected cases and the success rate is not proportional to the extent of neuronal tissue resection. So that, a greater resection cannot necessarily reduce the seizure frequency, however the morbidity may also be larger.

Functional hemispherectomy for the treatment of intractable seizures

Hemispherectomy is the most successful operation for the control of seizures in a very select group of patients with infantile hemiplegia and intractable epilepsy. The efficacy of anatomical hemispherectomy has been offset to some degree by the fact that up to one third of those operated upon will subsequently develop obstructive hydrocephalus, and the so-called superficial subpial cerebral hemosiderosis, with potentially fatal complications. This review article details the operative technique of a modified "functional" hemispherectomy. In essence, the technique consists of removing the central [Rolandic] cortex and the temporal lobe of the affected hemisphere and leaving the remainder of the hemisphere intact, but neurogenically disconnected from the remaining brain

Fatores de morbidade peroperatória relacionados a diferentes técnicas de hemisferectomia: análise de 30 pacientes / Factors affecting peroperative morbity of differeent techniques of hemipherectomy: study of 30 patients

Introdução. Compreender as complicações mais comuns da hemisferectomia é essencial para se estabelecer o melhor uso para a técnica. Métodos. Foram coletados dados de 30 pacientes, operados com quatro técnicas de hemisferectomia. Os fatores de morbidade foram avaliados dentro de rês perspectivas: 1- da doença de base; 2- da técnica utilizada; e 3- do fator humano. Resultados. Não houve diferença estatisticamente significativa entre as técnicas cirúrgicas empregadas nos itens: tempo cirúrgico; tempo de internação na unidade de terapia intensiva; queda da hemoglobina; volume de hemoderivados transfundidos e febre no pós-operatório. Conclusões: O principal fator de morbidade nas hemisferectomias é a doença de base, assim, não podemos concluir que uma técnica seja superior à outra / Understanding most common complications of hemispherectomy is an essential step to learn its use. Methods. Hospital charts from 30 patients oprated on with four techniques of hemispherectomy were reviewed. Morbidity was evaluated from 1- background disease, 2- employed technique, and 3- human factor. Results: our data presented no statistical difference among the employed techniques regarding 1- surgical time, 2- intensive care unit time, 3- per and postoperative fall of hemoglobin, 4- blood transfusion volume, and 5- postoperative axilar temperature variation. Conclusions: The main factors of morbidity in the hemispherectomy are the background disease and patient’s peculiarities, therefore, it is not reasonable to infer that there is a superior technique...