{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:54:08Z","timestamp":1783040048977,"version":"3.54.6"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Functional hemispherectomy is an effective surgical intervention for select patients with drug-resistant epilepsy. The last several decades have seen dramatic evolutions in preoperative evaluation, surgical techniques, and postoperative care. Here, the authors present a retrospective review of the medical records of 146 children who underwent hemispherectomy between 1987 and 2022 at The Hospital for Sick Children, providing a unique overview of the evolution of the procedure and patient outcomes over 35 years.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The medical records of all children who underwent hemispherectomy at The Hospital for Sick Children between 1987 and 2022 were reviewed. Demographic information, preoperative clinical features, short-term and long-term seizure outcomes, and details regarding postoperative complications were recorded.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The seizure outcomes of 146 children were analyzed. There were 68 females and 78 males with a mean age of 5.08 years, 123 of whom demonstrated seizure freedom (Engel class IA) in the short-term postoperative follow-up period and 89 in the long term. The effectiveness of hemispherectomy in achieving long-term seizure control has improved over time (\u03b2 = 0.06, p &lt; 0.001). Factors associated with overall seizure freedom included younger age at the time of hemispherectomy and stroke as the etiology of seizures, as well as complete disconnection during the first surgery. Additionally, the etiologies of epilepsy for which hemispherectomy is performed have expanded over time, while complication rates have remained unchanged.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Hemispherectomy is an increasingly effective treatment for certain cases of drug-resistant epilepsy. The etiologies of epilepsy for which hemispherectomy is performed are broadening, with no change in its safety profile. Seizure outcomes are better when the etiology of epilepsy is an ischemic injury, and the most common complication after the procedure is hydrocephalus. These findings reinforce the ongoing use of hemispherectomy as a safe and effective treatment option for certain individuals with drug-resistant epilepsy, support its application to a broader range of etiologies, and highlight areas of future investigation.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.4.peds23475","type":"journal-article","created":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T02:24:05Z","timestamp":1719627845000},"page":"252-259","source":"Crossref","is-referenced-by-count":7,"title":["Hemispherectomy at The Hospital for Sick Children: expanded indications and lessons learned over 35 years"],"prefix":"10.3171","volume":"34","author":[{"given":"Karim","family":"Mithani","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Quon","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Breitbart","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick E.","family":"Steadman","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladina","family":"Greuter","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver L.","family":"Richards","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann K.","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hrishikesh","family":"Suresh","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Malik","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"AlRamadan","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James T.","family":"Rutka","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"Lancet Neurol","first-page":"723","article-title":"Drug resistance in epilepsy","volume":"22","author":"Perucca E","year":"2023","unstructured":"Perucca E, Perucca P, White HS, Wirrell EC. Drug resistance in epilepsy. Lancet Neurol. 2023;22(8):723\u2013734."},{"issue":"5","key":"b2","series-title":"N Engl J Med","first-page":"311","article-title":"A randomized, controlled trial of surgery for temporal-lobe epilepsy","volume":"345","author":"Wiebe S","year":"2001","unstructured":"Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311\u2013318."},{"issue":"9","key":"b3","series-title":"JAMA","first-page":"922","article-title":"Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial","volume":"307","author":"Engel J Jr","year":"2012","unstructured":"Engel J Jr, McDermott MP, Wiebe S,  Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA. 2012;307(9):922\u2013930."},{"issue":"17","key":"b4","series-title":"N Engl J Med","first-page":"1639","article-title":"Surgery for drug-resistant epilepsy in children","volume":"377","author":"Dwivedi R","year":"2017","unstructured":"Dwivedi R, Ramanujam B, Chandra PS,  Surgery for drug-resistant epilepsy in children. N Engl J Med. 2017;377(17):1639\u20131647."},{"issue":"1","key":"b5","series-title":"Epilepsia","first-page":"103","article-title":"Beyond seizure freedom: dissecting long-term seizure control after surgical resection for drug-resistant epilepsy","volume":"64","author":"Hsieh JK","year":"2023","unstructured":"Hsieh JK, Pucci FG, Sundar SJ,  Beyond seizure freedom: dissecting long-term seizure control after surgical resection for drug-resistant epilepsy. Epilepsia. 2023;64(1):103\u2013113."},{"issue":"3","key":"b6","series-title":"Neurotherapeutics","first-page":"e00308","article-title":"Neurostimulation treatments for epilepsy: deep brain stimulation, responsive neurostimulation and vagus nerve stimulation","volume":"21","author":"Gouveia FV","year":"2024","unstructured":"Gouveia FV, Warsi NM, Suresh H, Matin R, Ibrahim GM. Neurostimulation treatments for epilepsy: deep brain stimulation, responsive neurostimulation and vagus nerve stimulation. Neurotherapeutics. 2024;21(3):e00308."},{"issue":"6","key":"b7","series-title":"Neurosurg Focus","first-page":"E11","article-title":"Hemispherectomy: historical review and recent technical advances","volume":"34","author":"Beier AD","year":"2013","unstructured":"Beier AD, Rutka JT. Hemispherectomy: historical review and recent technical advances. Neurosurg Focus. 2013;34(6):E11."},{"issue":"2","key":"b8","series-title":"Can J Neurol Sci","first-page":"71","article-title":"Hemispherectomy for seizures revisited","volume":"10","author":"Rasmussen T","year":"1983","unstructured":"Rasmussen T. Hemispherectomy for seizures revisited. Can J Neurol Sci. 1983;10(2):71\u201378."},{"issue":"11","key":"b9","series-title":"JAMA","first-page":"823","article-title":"Removal of right cerebral hemisphere for certain tumors with hemiplegia: preliminary report","volume":"90","author":"Dandy WE","year":"1928","unstructured":"Dandy WE. Removal of right cerebral hemisphere for certain tumors with hemiplegia: preliminary report. JAMA. 1928;90(11):823\u2013825."},{"issue":"11","key":"b10","series-title":"JAMA","first-page":"823","article-title":"Removal of the right cerebral hemisphere for infiltrating glioma: report of a case","volume":"101","author":"Gardner WJ","year":"1933","unstructured":"Gardner WJ. Removal of the right cerebral hemisphere for infiltrating glioma: report of a case. JAMA. 1933;101(11):823\u2013826."},{"issue":"4","key":"b11","series-title":"J Neurol Neurosurg Psychiatry","first-page":"243","article-title":"Infantile hemiplegia treated by removing one cerebral hemisphere","volume":"13","author":"Krynauw RA","year":"1950","unstructured":"Krynauw RA. Infantile hemiplegia treated by removing one cerebral hemisphere. J Neurol Neurosurg Psychiatry. 1950;13(4):243\u2013267."},{"issue":"3","key":"b12","series-title":"J Neurol Neurosurg Psychiatry","first-page":"229","article-title":"Persistent intracranial bleeding as a complication of hemispherectomy","volume":"29","author":"Oppenheimer DR","year":"1966","unstructured":"Oppenheimer DR, Griffith HB. Persistent intracranial bleeding as a complication of hemispherectomy. J Neurol Neurosurg Psychiatry. 1966;29(3):229\u2013240."},{"issue":"3-4","key":"b13","series-title":"World Neurosurg","first-page":"396","article-title":"Anatomic hemispherectomy: historical perspective","volume":"80","author":"Bahuleyan B","year":"2013","unstructured":"Bahuleyan B, Robinson S, Nair AR, Sivanandapanicker JL, Cohen AR. Anatomic hemispherectomy: historical perspective. World Neurosurg. 2013;80(3-4):396\u2013398."},{"issue":"5","key":"b14","series-title":"Rev Neurol","first-page":"466","article-title":"The effect of repeated leptomeningeal hemorrhages on the nervous system (marginal siderosis of the central nervous system). Article in French","volume":"112","author":"Ulrich J","year":"1965","unstructured":"Ulrich J, Isler W, Vassalli L. The effect of repeated leptomeningeal hemorrhages on the nervous system (marginal siderosis of the central nervous system). Article in French. Rev Neurol. 1965;112(5):466\u2013471."},{"key":"b15","series-title":"Trans Am Neurol Assoc","first-page":"133","article-title":"Postoperative superficial hemosiderosis of the brain, its diagnosis, treatment and prevention","volume":"98","author":"Rasmussen T","year":"1973","unstructured":"Rasmussen T. Postoperative superficial hemosiderosis of the brain, its diagnosis, treatment and prevention. Trans Am Neurol Assoc. 1973;98:133\u2013137."},{"issue":"11","key":"b16","series-title":"Childs Nerv Syst","first-page":"2103","article-title":"Functional hemispherectomy for catastrophic epilepsy in very young infants: technical considerations and complication avoidance","volume":"31","author":"Dorfer C","year":"2015","unstructured":"Dorfer C, Ochi A, Snead OC III,  Functional hemispherectomy for catastrophic epilepsy in very young infants: technical considerations and complication avoidance. Childs Nerv Syst. 2015;31(11):2103\u20132109."},{"issue":"2 Suppl Operative","key":"b17","series-title":"Neurosurgery","first-page":"429","article-title":"Hemispherectomy for the control of intractable epilepsy in childhood: comparison of 2 surgical techniques in a single institution","volume":"67","author":"Kwan A","year":"2010","unstructured":"Kwan A, Ng WH, Otsubo H,  Hemispherectomy for the control of intractable epilepsy in childhood: comparison of 2 surgical techniques in a single institution. Neurosurgery. 2010;67(2 Suppl Operative):429-436."},{"issue":"4","key":"b18","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Pediatric functional hemispherectomy: operative techniques and complication avoidance","volume":"48","author":"Young CC","year":"2020","unstructured":"Young CC, Williams JR, Feroze AH,  Pediatric functional hemispherectomy: operative techniques and complication avoidance. Neurosurg Focus. 2020;48(4):E9."},{"issue":"11","key":"b19","series-title":"Epilepsia","first-page":"2707","article-title":"Comparison of the real-world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug-resistant epilepsy: a post hoc analysis of the HOPS study","volume":"62","author":"Fallah A","year":"2021","unstructured":"Fallah A, Lewis E, Ibrahim GM,  Comparison of the real-world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug-resistant epilepsy: a post hoc analysis of the HOPS study. Epilepsia. 2021;62(11):2707\u20132718."},{"issue":"1","key":"b20","series-title":"Neuropediatrics","first-page":"53","article-title":"Functional hemispherectomy in children","volume":"24","author":"Villemure JG","year":"1993","unstructured":"Villemure JG, Rasmussen T. Functional hemispherectomy in children. Neuropediatrics. 1993;24(1):53\u201355."},{"issue":"7","key":"b21","series-title":"Childs Nerv Syst","first-page":"376","article-title":"Hemispherectomy for intractable seizures in children: a report of 58 cases","volume":"12","author":"Peacock WJ","year":"1996","unstructured":"Peacock WJ, Wehby-Grant MC, Shields WD,  Hemispherectomy for intractable seizures in children: a report of 58 cases. Childs Nerv Syst. 1996;12(7):376\u2013384."},{"issue":"10","key":"b22","series-title":"Epilepsia","first-page":"1771","article-title":"Long-term functional outcomes and their predictors after hemispherectomy in 115 children","volume":"54","author":"Moosa ANV","year":"2013","unstructured":"Moosa ANV, Jehi L, Marashly A,  Long-term functional outcomes and their predictors after hemispherectomy in 115 children. 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Can J Neurol Sci. 2021;48(4):451\u2013463."},{"issue":"4","key":"b25","series-title":"Neurology","first-page":"e410","article-title":"Comparison of hemispheric surgery techniques for pediatric drug-resistant epilepsy: an individual patient data meta-analysis","volume":"101","author":"Chen JS","year":"2023","unstructured":"Chen JS, Harris WB, Wu KJ,  Comparison of hemispheric surgery techniques for pediatric drug-resistant epilepsy: an individual patient data meta-analysis. Neurology. 2023;101(4):e410\u2013e424."},{"key":"b26","series-title":"Pediatric Neurosurgery for Clinicians","first-page":"615","article-title":"Hemispherectomy","author":"Muh CR","year":"2022","unstructured":"Muh CR. Hemispherectomy. In: Alexiou G, Prodromou N, eds.Pediatric Neurosurgery for Clinicians. Springer;2022:615-632."},{"issue":"3","key":"b27","series-title":"Childs Brain","first-page":"233","article-title":"Hemispherectomy for Sturge-Weber syndrome","volume":"5","author":"Hoffman HJ","year":"1979","unstructured":"Hoffman HJ, Hendrick EB, Dennis M, Armstrong D. Hemispherectomy for Sturge-Weber syndrome. Childs Brain. 1979;5(3):233\u2013248."},{"issue":"1","key":"b28","series-title":"Can J Neurol Sci","first-page":"78","article-title":"Sturge-Weber-Dimitri disease: role of hemispherectomy in prognosis","volume":"16","author":"Ogunmekan AO","year":"1989","unstructured":"Ogunmekan AO, Hwang PA, Hoffman HJ. Sturge-Weber-Dimitri disease: role of hemispherectomy in prognosis. Can J Neurol Sci. 1989;16(1):78\u201380."},{"key":"b29","article-title":"Surgical Treatment of the Epilepsies","year":"1987","unstructured":"Engel J, ed .Surgical Treatment of the Epilepsies. Raven Press;1987."},{"issue":"5","key":"b30","series-title":"Epilepsia","first-page":"1064","article-title":"Hemispherectomy Outcome Prediction Scale: development and validation of a seizure freedom prediction tool","volume":"62","author":"Weil AG","year":"2021","unstructured":"Weil AG, Lewis EC, Ibrahim GM,  Hemispherectomy Outcome Prediction Scale: development and validation of a seizure freedom prediction tool. Epilepsia. 2021;62(5):1064\u20131073."},{"key":"b31","series-title":"Pediatr Neurol","first-page":"58","article-title":"Epidemiology and outcomes of arterial ischemic stroke in children: the Canadian Pediatric Ischemic Stroke Registry","volume":"69","author":"deVeber GA","year":"2017","unstructured":"deVeber GA, Kirton A, Booth FA,  Epidemiology and outcomes of arterial ischemic stroke in children: the Canadian Pediatric Ischemic Stroke Registry. Pediatr Neurol. 2017;69:58\u201370."},{"issue":"2","key":"b32","series-title":"Epilepsia","first-page":"383","article-title":"Posthemispherectomy hydrocephalus: results of a comprehensive, multiinstitutional review","volume":"54","author":"Lew SM","year":"2013","unstructured":"Lew SM, Matthews AE, Hartman AL, Haranhalli N. Posthemispherectomy hydrocephalus: results of a comprehensive, multiinstitutional review. Epilepsia. 2013;54(2):383\u2013389."},{"issue":"6","key":"b33","series-title":"J Neurosurg Pediatr","first-page":"545","article-title":"The natural history of postoperative hydrocephalus after pediatric hemispherectomy for medically refractory epilepsy: an institutional experience","volume":"31","author":"Lu VM","year":"2023","unstructured":"Lu VM, Wang S, Ragheb J. The natural history of postoperative hydrocephalus after pediatric hemispherectomy for medically refractory epilepsy: an institutional experience. J Neurosurg Pediatr. 2023;31(6):545\u2013550."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/34\/3\/article-p252.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/34\/3\/article-p252.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/34\/3\/article-p252.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:07:16Z","timestamp":1733490436000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/34\/3\/article-p252.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,1]]},"references-count":33,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2024.4.peds23475","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,1]]}}}