{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T01:39:41Z","timestamp":1780882781912,"version":"3.54.1"},"reference-count":74,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,21]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Hemispherotomy and posterior quadrant disconnection (PQD) are standard surgical treatments for medically intractable epilepsy in pediatric patients. However, the current academic literature is limited on their efficacy and safety in very young patients. This study evaluates the outcomes of patients \u2264 12 months of age who underwent hemispherotomy or PQD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors retrospectively reviewed the medical records of patients \u2264 12 months of age who underwent epilepsy surgery at Washington University and St. Louis Children\u2019s Hospital from 2003 to 2023. Data on diagnosis, age at surgery, operative details, hospital length of stay, and complications were reported. The Engel classification and Gross Motor Function Classification System (GMFCS) were used to assess seizure and motor outcomes, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 14 patients who underwent either hemispherotomy (n = 12) or PQD (n = 2) were included. Overall, 57% had a diagnosis of hemimegaloencephaly, 29% had middle cerebral artery infarcts, and 14% had cortical development malformation. The mean age at surgery was 6 months, with the youngest child being 2 months of age. The mean estimated blood loss was 58% of the total blood volume. The mean duration of follow-up was 4.8 years. At 1 year postoperatively, seizure freedom was 75%. At the last follow-up, 54% of patients were free of disabling seizures (Engel class I), with 57% of this subgroup being completely seizure free (Engel class IA). Of the remaining patients, 23% experienced rare disabling seizures (Engel class II) and 23% experienced worthwhile improvement (Engel class III). At the last follow-up, 67% of patients had a GMFCS level of I or II (walking with no or some limitations) and 33% had a GMFCS level of IV (assisted self-mobility). There were no deaths or long-term postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Hemispherotomy and PQD in children \u2264 12 months of age are associated with meaningful seizure control and improved motor outcomes. These procedures should be considered for the treatment of medically refractory epilepsy, even in very young infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.7.peds2577","type":"journal-article","created":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T02:16:22Z","timestamp":1763777782000},"page":"11-19","source":"Crossref","is-referenced-by-count":1,"title":["Hemispherotomy and posterior quadrant disconnection in infants: outcomes in patients \u2264 12 months of age"],"prefix":"10.3171","volume":"37","author":[{"given":"Afshin","family":"Salehi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska;"},{"name":"Department of Neurosurgery, Children\u2019s Nebraska, Omaha, Nebraska;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spencer D.","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H.","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, McGovern Medical School at UTHealth Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myron L.","family":"Rolle","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins All Children\u2019s Hospital, Tampa, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarod L.","family":"Roland","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"Smyth","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins All Children\u2019s Hospital, Tampa, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Epilepsia","first-page":"19","article-title":"Incidence of epilepsy in childhood and adolescence: a population-based study in Nova Scotia from 1977 to 1985","volume":"37","author":"Camfield CS","year":"1996","unstructured":"Camfield CS, Camfield PR, Gordon K, Wirrell E, Dooley JM. Incidence of epilepsy in childhood and adolescence: a population-based study in Nova Scotia from 1977 to 1985. Epilepsia. 1996;37(1):19\u201323."},{"issue":"5","key":"b2","series-title":"Pediatrics","first-page":"e20163908","article-title":"Incidence and prevalence of childhood epilepsy: a nationwide cohort study","volume":"139","author":"Aaberg KM","year":"2017","unstructured":"Aaberg KM, Gunnes N, Bakken IJ,  Incidence and prevalence of childhood epilepsy: a nationwide cohort study. Pediatrics. 2017;139(5):e20163908."},{"issue":"9","key":"b3","series-title":"Epilepsia","first-page":"1563","article-title":"Predictors and course of medically intractable epilepsy in young children presenting before 36 months of age: a retrospective, population-based study","volume":"53","author":"Wirrell E","year":"2012","unstructured":"Wirrell E, Wong-Kisiel L, Mandrekar J, Nickels K. Predictors and course of medically intractable epilepsy in young children presenting before 36 months of age: a retrospective, population-based study. Epilepsia. 2012;53(9):1563\u20131569."},{"issue":"4","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"400","article-title":"Functional hemispherotomy for epilepsy in the very young","volume":"30","author":"Pepper J","year":"2022","unstructured":"Pepper J, Lo WB, Agrawal S,  Functional hemispherotomy for epilepsy in the very young. J Neurosurg Pediatr. 2022;30(4):400\u2013409."},{"issue":"6","key":"b5","series-title":"Epilepsia","first-page":"1442","article-title":"Epilepsy surgery in the first 3 years of life: a Canadian survey","volume":"50","author":"Steinbok P","year":"2009","unstructured":"Steinbok P, Gan PYC, Connolly MB,  Epilepsy surgery in the first 3 years of life: a Canadian survey. 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J Neurosurg Pediatr. 2010;5(6):603\u2013607."},{"issue":"2 suppl 1","key":"b8","series-title":"Oper Neurosurg","first-page":"ONS19","article-title":"Vertical parasagittal hemispherotomy: surgical procedures and clinical long-term outcomes in a population of 83 children","volume":"60","author":"Delalande O","year":"2007","unstructured":"Delalande O, Bulteau C, Dellatolas G,  Vertical parasagittal hemispherotomy: surgical procedures and clinical long-term outcomes in a population of 83 children. Oper Neurosurg. 2007;60(2 suppl 1):ONS19\u2013ONS32."},{"issue":"9","key":"b9","series-title":"Epilepsia","first-page":"1518","article-title":"Hemispherectomy for catastrophic epilepsy in infants","volume":"46","author":"Gonz\u00e1lez-Mart\u00ednez JA","year":"2005","unstructured":"Gonz\u00e1lez-Mart\u00ednez JA, Gupta A, Kotagal P,  Hemispherectomy for catastrophic epilepsy in infants. Epilepsia. 2005;46(9):1518\u20131525."},{"issue":"6","key":"b10","series-title":"Oper Neurosurg","first-page":"449","article-title":"Posterior quadrant disconnection procedure for intractable epilepsy: a case series of 5 young pediatric patients","volume":"23","author":"Patel SK","year":"2022","unstructured":"Patel SK, Gibson JL, Lovha M,  Posterior quadrant disconnection procedure for intractable epilepsy: a case series of 5 young pediatric patients. Oper Neurosurg. 2022;23(6):449\u2013456."},{"issue":"6","key":"b11","series-title":"Neurosurg","first-page":"E368","article-title":"Epilepsy surgery in the first 3 years of life: predictors of seizure freedom and cognitive development","volume":"84","author":"Kadish NE","year":"2019","unstructured":"Kadish NE, Bast T, Reuner G,  Epilepsy surgery in the first 3 years of life: predictors of seizure freedom and cognitive development. 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N Engl J Med. 1996;334(10):647\u2013652."},{"issue":"4","key":"b16","series-title":"Dev Med Child Neurol","first-page":"214","article-title":"Development and reliability of a system to classify gross motor function in children with cerebral palsy","volume":"39","author":"Palisano R","year":"1997","unstructured":"Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214\u2013223."},{"issue":"3","key":"b17","series-title":"Neurosurgery","first-page":"509","article-title":"Hemispherical deafferentation: an alternative to functional hemispherectomy","volume":"36","author":"Schramm J","year":"1995","unstructured":"Schramm J, Behrens E, Entzian W. Hemispherical deafferentation: an alternative to functional hemispherectomy. Neurosurgery. 1995;36(3):509\u2013516."},{"issue":"4","key":"b18","series-title":"J Neurosurg Pediatr","first-page":"323","article-title":"Hemispherotomy: efficacy and analysis of seizure recurrence","volume":"4","author":"Limbrick DD","year":"2009","unstructured":"Limbrick DD, Narayan P, Powers AK,  Hemispherotomy: efficacy and analysis of seizure recurrence. J Neurosurg Pediatr. 2009;4(4):323\u2013332."},{"issue":"8","key":"b19","series-title":"Epilepsia","first-page":"1429","article-title":"Posterior quadrantic epilepsy surgery: technical variants, surgical anatomy, and case series","volume":"48","author":"Daniel RT","year":"2007","unstructured":"Daniel RT, Meagher-Villemure K, Farmer JP, Andermann F, Villemure JG. Posterior quadrantic epilepsy surgery: technical variants, surgical anatomy, and case series. 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