Introduction: Hemispherotomy is an effective treatment for children with drug-resistant epilepsy (DRE). While hemispherotomy techniques and indications have evolved, access remains predominantly constrained to high resource settings. Methods: We performed a retrospective analysis of children who underwent hemispherotomy from 2011 to 2023 by a hybrid team, including local Panamanian and US neurologists, neurosurgeons and EEG technicians and analyzed surgical, epilepsy and quality of life (QoL) parameters. Follow-up data was collected according to the International Consortium for Health Outcomes Measurement (ICHOM) guidelines for children with epilepsy. Results: Twenty-three children underwent hemispherotomy. The median age at surgery was 10 years (range 2–20). The median follow-up time was six years (range 1–13). The etiology of DRE included malformations of cortical development in 14 children (60.8%), including 8 (34.8%) with schizencephaly, and secondary causes in 9 children (39.1%). Seizure frequency improved for all 23 children (100%): Engel I was achieved in 15 children (65.2%), Engel II (26.1%) in six children, and Engel III (8.7%) in two children. Patients with seizure freedom had significantly fewer preoperative seizures per day than patients with seizure recurrence. Complications occurred in six children (26.1%): 2 wound infections, 2 meningitis, 1 femoral vein thrombosis and 1 wound hematoma with return to OR. There was no perioperative mortality, and no postoperative hydrocephalus or CSF diversion. QoL-related outcomes were available for 16 children: 16/16 (100%) reported that the surgery was a worthwhile and repeatable choice, 14 (87.5%) reported improved cognitive function, the median QOLCE-16 score was 62.5±21. Conclusion: Hemispherotomy for DRE in select children is a safe and effective surgery in a public children’s hospital in a low-resource setting. At last follow-up, the majority of children were seizure-free, and all children had decreased seizure frequency. Families reported improved cognitive function, improved QoL and high satisfaction with their decision to pursue this surgery.
Rhodenhiser et al. (Thu,) studied this question.