{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T02:56:08Z","timestamp":1778813768021,"version":"3.51.4"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,2]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Drug-resistant epilepsy (DRE) can arise early in life due to multiple structural abnormalities. In patients with the disorder, seizures can be difficult to control and can significantly impair neurodevelopment. Hemispherectomy is well described as a treatment for refractory hemispheric-onset epilepsy, but its use in infants has been limited due to concerns over surgical risk and physiological tolerance. The aim of this review was to summarize an institutional experience with hemispherectomy in infants to demonstrate the safety and efficacy of the technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective chart review was conducted to identify children younger than 1 year of age who had undergone a modified functional hemispherectomy combining elements of both hemispherotomy and anatomical resection to treat DRE at Seattle Children\u2019s Hospital from 2000 to 2024. The primary outcome was favorable seizure outcome, defined as Engel class I\u2013II at the 1-year follow-up. Secondary outcomes included perioperative complications, development of postoperative hydrocephalus, need for long-term nutritional supplementation, and changes in the anti-seizure medication burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Twenty-one children who had undergone functional hemispherectomy were identified, revealing a mean age of 6.2 months (range 0.93\u201312.3 months) at surgery. The most common etiology was hemimegalencephaly (n = 11, 52%). No serious cardiac, pulmonary, or coagulopathic adverse events occurred, although complications included asymptomatic cerebral venous sinus thrombosis (n = 1, 5%), postoperative hydrocephalus (n = 3, 14%), and electrolyte derangements (n = 1, 5%). The mean hospital stay was 12.5 days (range 6\u201334 days). Hydrocephalus developed &gt; 12 months postoperatively in 2 (67%) of the 3 patients with this complication. The mean estimated blood loss was 345.8 mL (150\u2013700 mL), and all patients received a transfusion during their surgery with a mean transfusion volume of 450.2 mL (60.4 mL\/kg). Seizure outcomes were uniformly assessed at the last clinical follow-up, with a mean follow-up duration of 91.9 months (range 6.1\u2013261.6 months). A favorable seizure outcome (Engel class I\u2013II) was attained in 20 patients (95%), with an Engel class I outcome in 19 patients (90%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>An institutional experience demonstrated that functional hemispherectomy is a safe and well-tolerated procedure in infants and offers excellent seizure control outcomes in hemispheric-onset epilepsies. The surgical technique, a focus on minimizing operative blood loss, and multidisciplinary care of these patients are critical elements in ensuring the safety and success of this procedure. Future studies are needed to better characterize long-term functional and neurodevelopmental outcomes in this age group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.9.peds25241","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T17:46:17Z","timestamp":1767894377000},"page":"220-226","source":"Crossref","is-referenced-by-count":1,"title":["Hemispherectomy in infants: an institutional experience with 21 patients"],"prefix":"10.3171","volume":"37","author":[{"given":"Dominic","family":"Nistal","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Washington & Division of Neurosurgery, Seattle Children\u2019s Hospital, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Buckley","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington & Division of Neurosurgery, Seattle Children\u2019s Hospital, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Boop","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington & Division of Neurosurgery, Seattle Children\u2019s Hospital, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah E.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington & Division of Neurosurgery, Seattle Children\u2019s Hospital, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey G.","family":"Ojemann","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington & Division of Neurosurgery, Seattle Children\u2019s Hospital, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard G.","family":"Ellenbogen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington & Division of Neurosurgery, Seattle Children\u2019s Hospital, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason S.","family":"Hauptman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Phoenix Children\u2019s Hospital, Phoenix, Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Pediatr Neurol","first-page":"336","article-title":"Surgery for intractable epilepsy due to unilateral brain disease: a retrospective study comparing hemispherectomy techniques","volume":"51","author":"Pinto ALR","year":"2014","unstructured":"Pinto ALR, Lohani S, Bergin AMR,  Surgery for intractable epilepsy due to unilateral brain disease: a retrospective study comparing hemispherectomy techniques. Pediatr Neurol. 2014;51(3):336\u2013343."},{"issue":"5","key":"b2","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."},{"issue":"1","key":"b3","series-title":"J Pediatr Neurosci","first-page":"106","article-title":"Hemimegalencephaly: seizure outcome in an infant after hemispherectomy","volume":"13","author":"Chand P","year":"2018","unstructured":"Chand P, Manglani P, Abbas Q. Hemimegalencephaly: seizure outcome in an infant after hemispherectomy. J Pediatr Neurosci. 2018;13(1):106\u2013108."},{"issue":"9","key":"b4","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":"3-4","key":"b5","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":"4","key":"b6","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":"1","key":"b7","series-title":"Seizure","first-page":"49","article-title":"Early hemispherectomy in catastrophic epilepsy: a neuro-cognitive and epileptic long-term follow-up","volume":"17","author":"Lettori D","year":"2008","unstructured":"Lettori D, Battaglia D, Sacco A,  Early hemispherectomy in catastrophic epilepsy: a neuro-cognitive and epileptic long-term follow-up. Seizure. 2008;17(1):49\u201363."},{"issue":"Pt 9","key":"b8","series-title":"Brain","first-page":"2071","article-title":"Functional consequences of hemispherectomy","volume":"127","author":"van Empelen R","year":"2004","unstructured":"van Empelen R, Jennekens-Schinkel A, Buskens E, Helders PJM, van Nieuwenhuizen O. Functional consequences of hemispherectomy. Brain. 2004;127(Pt 9):2071\u20132079."},{"issue":"6","key":"b9","series-title":"Epilepsia","first-page":"952","article-title":"Proposed criteria for referral and evaluation of children for epilepsy surgery: recommendations of the Subcommission for Pediatric Epilepsy Surgery","volume":"47","author":"Cross JH","year":"2006","unstructured":"Cross JH, Jayakar P, Nordli D,  Proposed criteria for referral and evaluation of children for epilepsy surgery: recommendations of the Subcommission for Pediatric Epilepsy Surgery. Epilepsia. 2006;47(6):952\u2013959."},{"issue":"5","key":"b10","series-title":"Pediatr Neurol","first-page":"452","article-title":"Goyal M. Hemispherectomy for hemimegalencephaly due to tuberous sclerosis and a review of the literature","volume":"53","author":"Cuddapah VA","year":"2015","unstructured":"Cuddapah VA, Thompson M, Blount J, Li R, Guleria S. Goyal M. Hemispherectomy for hemimegalencephaly due to tuberous sclerosis and a review of the literature. Pediatr Neurol. 2015;53(5):452\u2013455."},{"issue":"1","key":"b11","series-title":"Epilepsy Res","first-page":"47","article-title":"Hemispherectomy-associated complications from the Kids\u2019 Inpatient Database","volume":"87","author":"Koubeissi MZ","year":"2009","unstructured":"Koubeissi MZ, Syed TU, Syed I, Jordan J, Alshekhlee A, Kossoff EH. Hemispherectomy-associated complications from the Kids\u2019 Inpatient Database. Epilepsy Res. 2009;87(1):47\u201353."},{"issue":"2 Pt 1","key":"b12","series-title":"Pediatrics","first-page":"163","article-title":"Why would you remove half a brain? The outcome of 58 children after hemispherectomy\u2014the Johns Hopkins experience: 1968 to 1996","volume":"100","author":"Vining EP","year":"1997","unstructured":"Vining EP, Freeman JM, Pillas DJ,  Why would you remove half a brain? The outcome of 58 children after hemispherectomy\u2014the Johns Hopkins experience: 1968 to 1996. Pediatrics. 1997;100(2 Pt 1):163\u2013171."},{"issue":"2","key":"b13","series-title":"J Clin Anesth","first-page":"91","article-title":"Management of cerebral hemispherectomy in children","volume":"2","author":"Brian JE","year":"1990","unstructured":"Brian JE, Deshpande JK, McPherson RW. Management of cerebral hemispherectomy in children. J Clin Anesth. 1990;2(2):91\u201395."},{"issue":"7","key":"b14","series-title":"Childs Nerv Syst","first-page":"453","article-title":"Hemispherectomy procedures in children: haematological issues","volume":"20","author":"Piastra M","year":"2004","unstructured":"Piastra M, Pietrini D, Caresta E,  Hemispherectomy procedures in children: haematological issues. Childs Nerv Syst. 2004;20(7):453\u2013458."},{"issue":"4","key":"b15","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":"10","key":"b16","series-title":"Paediatr Anaesth","first-page":"967","article-title":"Ojemann J, Haberkern C. 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Epilepsia Open. 2023;8(3):1182\u20131189."},{"issue":"4","key":"b22","series-title":"Br J Anaesth","first-page":"459","article-title":"Tranexamic acid for safer surgery: the time is now","volume":"129","author":"Grocott MPW","year":"2022","unstructured":"Grocott MPW, Murphy M, Roberts I, Sayers R, Toh CH. Tranexamic acid for safer surgery: the time is now. Br J Anaesth. 2022;129(4):459\u2013461."},{"issue":"3","key":"b23","series-title":"Neurosurg Rev","first-page":"1287","article-title":"Tranexamic acid in neurosurgery: a controversy indication-review","volume":"44","author":"de Faria JL","year":"2021","unstructured":"de Faria JL, da Silva Brito J, Costa E Silva LT,  Tranexamic acid in neurosurgery: a controversy indication-review. Neurosurg Rev. 2021;44(3):1287\u20131298."},{"issue":"1","key":"b24","series-title":"J Neurosurg Pediatr","first-page":"95","article-title":"Dysphagia after pediatric functional hemispherectomy","volume":"13","author":"Buckley RT","year":"2014","unstructured":"Buckley RT, Morgan T, Saneto RP, Barber J, Ellenbogen RG, Ojemann JG. Dysphagia after pediatric functional hemispherectomy. J Neurosurg Pediatr. 2014;13(1):95\u2013100."},{"issue":"8","key":"b25","series-title":"Brain Dev","first-page":"742","article-title":"Epilepsy surgery for hemispheric syndromes in infants: hemimegalencepahly and hemispheric cortical dysplasia","volume":"35","author":"Bulteau C","year":"2013","unstructured":"Bulteau C, Otsuki T, Delalande O. Epilepsy surgery for hemispheric syndromes in infants: hemimegalencepahly and hemispheric cortical dysplasia. Brain Dev. 2013;35(8):742\u2013747."},{"issue":"6","key":"b26","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."},{"issue":"2","key":"b27","series-title":"Epilepsia","first-page":"383","article-title":"Post-hemispherectomy hydrocephalus: results of a comprehensive, multi-institutional review","volume":"54","author":"Lew SM","year":"2013","unstructured":"Lew SM, Matthews AE, Hartman AL, Haranhalli N. Post-hemispherectomy hydrocephalus: results of a comprehensive, multi-institutional review. 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J Pediatr Neurosci. 2018;13(1):106\u2013108."},{"issue":"9","key":"b4","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":"3-4","key":"b5","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. 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Epilepsia. 2006;47(6):952\u2013959."},{"issue":"5","key":"b10","series-title":"Pediatr Neurol","first-page":"452","article-title":"Goyal M. Hemispherectomy for hemimegalencephaly due to tuberous sclerosis and a review of the literature","volume":"53","author":"Cuddapah VA","year":"2015","unstructured":"Cuddapah VA, Thompson M, Blount J, Li R, Guleria S. Goyal M. Hemispherectomy for hemimegalencephaly due to tuberous sclerosis and a review of the literature. Pediatr Neurol. 2015;53(5):452\u2013455."},{"issue":"1","key":"b11","series-title":"Epilepsy Res","first-page":"47","article-title":"Hemispherectomy-associated complications from the Kids\u2019 Inpatient Database","volume":"87","author":"Koubeissi MZ","year":"2009","unstructured":"Koubeissi MZ, Syed TU, Syed I, Jordan J, Alshekhlee A, Kossoff EH. Hemispherectomy-associated complications from the Kids\u2019 Inpatient Database. Epilepsy Res. 2009;87(1):47\u201353."},{"issue":"2 Pt 1","key":"b12","series-title":"Pediatrics","first-page":"163","article-title":"Why would you remove half a brain? The outcome of 58 children after hemispherectomy\u2014the Johns Hopkins experience: 1968 to 1996","volume":"100","author":"Vining EP","year":"1997","unstructured":"Vining EP, Freeman JM, Pillas DJ,  Why would you remove half a brain? The outcome of 58 children after hemispherectomy\u2014the Johns Hopkins experience: 1968 to 1996. Pediatrics. 1997;100(2 Pt 1):163\u2013171."},{"issue":"2","key":"b13","series-title":"J Clin Anesth","first-page":"91","article-title":"Management of cerebral hemispherectomy in children","volume":"2","author":"Brian JE","year":"1990","unstructured":"Brian JE, Deshpande JK, McPherson RW. Management of cerebral hemispherectomy in children. 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Neurosurgery. 2007;60(2 Suppl 1):ONS19\u2013ONS32."},{"issue":"2","key":"b18","series-title":"J Neurosurg Pediatr","first-page":"178","article-title":"Endoscope-assisted hemispherotomy: translation of technique from cadaveric anatomical feasibility study to clinical implementation","volume":"23","author":"Wagner K","year":"2019","unstructured":"Wagner K, Vaz-Guimaraes F, Camstra K, Lam S. Endoscope-assisted hemispherotomy: translation of technique from cadaveric anatomical feasibility study to clinical implementation. J Neurosurg Pediatr. 2019;23(2):178\u2013186."},{"issue":"8","key":"b19","series-title":"Childs Nerv Syst","first-page":"967","article-title":"Peri-insular hemispherotomy in paediatric epilepsy","volume":"22","author":"Villemure JG","year":"2006","unstructured":"Villemure JG, Daniel RT. Peri-insular hemispherotomy in paediatric epilepsy. 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