Timing and type of hemispherectomy for Rasmussen's encephalitis: Analysis of 45 patients.

ABSTRACT

OBJECTIVE: To describe the surgery outcomes of RE patients in one centerto identify the indication for surgical treatment that results in the most favorable outcome. METHOD: Forty-five RE patients from a single center were retrospectively reviewed. Preoperative evaluations included assessments of clinical manifestations, cognitive status, a physical examination, MRI, positron emission tomography (PET), electroencephalography (EEG), and magnetoencephalography (MEG). The surgical outcomes included seizure outcome, neurological function, EEG, a cognitive evaluation, and antiepileptic drug withdrawal. RESULTS: A total of 45 children (29 male) with RE were included in this study. The mean follow-up period from the first operation was 31.7months (range 6-96). The patients who underwent anatomical hemispherectomy or hemisphere disconnection had better seizure outcomes without greater perioperative complications compared with the patients who underwent functional hemispherectomy. Reoperative hemispherectomy was a safe and effective treatment for patients with postoperative epilepsy recurrence. After the last surgery, 34 patients (74.4%) were evaluated as Engel class I. Most of the patients had favorable neurological outcomes. Analysis revealed that the patientswith IQs greater 70 who underwent operations were more likely to suffer from IQ declines but were also more likely to have higher IQs in the future. SIGNIFICANCE: Compared with functional hemispherectomy and hemisphere disconnection, anatomical hemispherectomy elicited better seizure outcomes with an acceptable level of complications. Early stage operations might lead to better cognitive status, but they are associated with a high risk of IQ decline.