{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T10:53:53Z","timestamp":1785581633617,"version":"3.56.0"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Although hemispherectomy is an effective treatment for children with intractable hemispheric epilepsy syndromes, as many as 40% of patients eventually develop seizure recurrence. The causes of seizure recurrence in these patients are incompletely understood. The authors sought to evaluate the efficacy of hemispherectomy at their center and determine whether contralateral MRI abnormalities can predict seizure recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A retrospective review of consecutive hemispherectomies performed at Miami Children\u2019s Hospital between January 2000 and June 2014 was performed. Time-to-event analysis was performed. The \u201cevent\u201d was defined as any seizures following resective epilepsy surgery (not including seizures in the first postoperative week and auras). Several preoperative variables were analyzed to determine their suitability to predict seizure recurrence following surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Sixty-nine patients (44 boys) with a mean age of 8.2 \u00b1 5.9 years (range 0.1\u201320.8 years) underwent 72 hemispherectomies; 67 of these were functional hemispherectomies, while another 5 were completion of a previous functional hemispherectomy (2 completions of functional hemispherectomies, 3 anatomical hemispherectomies). The duration of epilepsy was 5.8 \u00b1 5.5 years with 66 cases (91.7%) having daily seizures. Etiology included stroke (n = 28), malformation of cortical development (n = 11), hemimegalencephaly (n = 11), encephalitis (n = 13), and other (n = 7). Engel class I outcome was achieved in 59 (86%) and 56 (81%) patients at 1 and 2 years of follow-up, respectively. The mean time to seizure recurrence was 33.5 \u00b1 31.1 months. In univariate analyses, the absence of contralateral abnormalities on MRI (HR 4.09, 95% CI 1.41\u201311.89, p = 0.009) was associated with a longer duration of seizure freedom. The presence of contralateral MRI abnormalities was associated with contralateral ictal seizures on preoperative scalp EEG (p = 0.002). Fifteen patients experienced 20 complications (20\/72, 27.8%), including the development of hydrocephalus necessitating CSF diversion in 9 cases (13%), hygroma in 1, hemispheric edema in 1, aseptic meningitis in 2, postoperative hemorrhage in 2, infection in 2, ischemic stroke in 2, and blood transfusion\u2013contracted hepatitis C in 1 case.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Patients with bihemispheric abnormalities, as evidenced by contralateral MRI abnormalities, have a higher risk of earlier seizure recurrence following functional hemispherectomy.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.12.peds19370","type":"journal-article","created":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T18:48:51Z","timestamp":1583434131000},"page":"567-573","source":"Crossref","is-referenced-by-count":18,"title":["Functional hemispherectomy: can preoperative imaging predict outcome?"],"prefix":"10.3171","volume":"25","author":[{"given":"Alexander G.","family":"Weil","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Sainte Justine Hospital, Montreal, Quebec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aria","family":"Fallah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, UCLA Mattel Children\u2019s Hospital, David Geffen School of Medicine at University of California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelly","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, Brain Institute, Miami Children\u2019s Hospital, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lior M.","family":"Elkaim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasanna","family":"Jayakar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, Brain Institute, Miami Children\u2019s Hospital, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, Brain Institute, Miami Children\u2019s Hospital, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjiv","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, Brain Institute, Miami Children\u2019s Hospital, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toba N.","family":"Niazi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, Brain Institute, Miami Children\u2019s Hospital, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Ragheb","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Neurosurgery, Brain Institute, Miami Children\u2019s Hospital, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1212\/01.WNL.0000150580.40019.63","article-title":"Resective surgery to treat refractory status epilepticus in children with focal epileptogenesis","volume":"64","author":"Alexopoulos A","year":"2005","unstructured":"Alexopoulos A, Lachhwani DK, Gupta A, Kotagal P, Harrison AM, Bingaman W, : Resective surgery to treat refractory status epilepticus in children with focal epileptogenesis. 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