Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
The 71st Annual Meeting Special Topics—Part I: Long-Term Functional Outcome of Epilepsy Surgery
Which is the Most Appropriate Disconnection Surgery for Refractory Epilepsy in Childhood?
Haruhiko KISHIMASatoru OSHINONaoki TANIYomoyuki MARUOShayne MORRISHui Ming KHOOTakufumi YANAGISAWAKuriko SHIMONOTakeshi OKINAGAMasayuki HIRATAAmami KATOToshiki YOSHIMINE
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JOURNALS OPEN ACCESS

2013 Volume 53 Issue 11 Pages 814-820

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Abstract

Children with unilobar or multilobar pathology issuing in refractory epilepsy are potential candidates for surgical treatment. Extensive surgery results in good seizure control, but it also increases the risk of neurological deficits as well as motor and mental problems. We reviewed the cases of 19 children with refractory epilepsy treated surgically at Osaka University Hospital. Four of the 19 patients underwent temporal disconnection, 2 underwent occipital lobectomy, 4 underwent temporoparietooccipital disconnection, 6 underwent functional hemispherotomy, and 3 underwent corpus callosotomy. A good surgical outcome, i.e., Engel’s class I or II, was achieved in 12 (63%) of the 19 patients. Excellent surgical outcomes and satisfactory motor and mental development were achieved in 4 patients who underwent temporoparietooccipital disconnection. The outcomes of functional hemispherectomy were also satisfactory. The outcomes of temporal disconnection and corpus callosotomy were poor in comparison to outcomes of the other procedures. We believe that better surgical outcomes would have been achieved with temporoparietooccipital disconnection in some cases treated by temporal disconnection or occipital resection. Adequate extensive surgical procedures should be considered for refractory childhood epilepsy arising from unilobar or multilobar pathology.

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