Zheng Vincent, Lehtinen Henri, Karppinen Atte, Gaily Eija, Leinonen Heta, Koroknay-Pál Päivi, Laakso Aki, Metsähonkala Eeva-Liisa
1Departments of Neurosurgery and.
3Epilepsia-Helsinki, Helsinki University Hospital, Helsinki, Finland.
J Neurosurg Pediatr. 2024 Oct 25;35(1):46-56. doi: 10.3171/2024.9.PEDS24281. Print 2025 Jan 1.
The goal of this study was to assess the complications associated with vertical parasagittal hemispherotomy (VPH), the impact of incomplete disconnection on long-term seizure freedom, and how VPH impacts cognitive development.
A retrospective evaluation was performed in all patients who had undergone VPH during 1991-2022 at the authors' institution. Two-year follow-up data were available for 45 patients, and there were 6-month data for 3 more. All available postoperative MRI studies (31/48, 64.6%) were reviewed. Before 2010, postoperative MRI was only performed if seizures recurred.
Primary VPH led to Engel class I in 73% of patients. Acquired etiologies had a higher rate of Engel I compared to developmental and progressive etiologies (96% vs 46% and 44%, p < 0.001). Nearly half of patients (45%) showed improved cognitive trajectories as opposed to their preoperative ones, whereas in 45% trajectories remained unchanged. Additionally, 5 patients (10%) exhibited new major deficits or accelerated cognitive deterioration after VPH. Surgical complications occurred in 14 patients (29%) after the first VPH; 4 cases were classified as transient, resolving during follow-up without surgical intervention. Nontransient complications included 8 cases of hydrocephalus requiring surgical treatment, 1 shunted subdural hygroma, and 1 case of CSF leakage from the wound. Diabetes insipidus occurred in 6 patients, with all resolving spontaneously. Residual connections were present in 16 patients, primarily in the temporomesial region. Seven patients remained seizure free despite visible residual connections.
VPH is a highly effective treatment for drug-resistant hemispheric epilepsy, resulting in durable seizure freedom and often favorable cognitive outcomes. Diabetes insipidus in addition to hydrocephalus is a common complication after VPH. Incomplete disconnection does not necessarily preclude seizure freedom.
本研究的目的是评估垂直矢状旁半球切开术（VPH）相关的并发症、不完全离断对长期无癫痫发作的影响，以及VPH对认知发育的影响。
对1991年至2022年期间在作者所在机构接受VPH手术的所有患者进行回顾性评估。45例患者有两年的随访数据，另外3例有6个月的数据。回顾了所有可用的术后MRI研究（31/48，64.6%）。2010年之前，仅在癫痫复发时才进行术后MRI检查。
原发性VPH使73%的患者达到恩格尔I级。与发育性和进行性病因相比，后天性病因的恩格尔I级发生率更高（96%对46%和44%，p<0.001）。近一半的患者（45%）与术前相比显示出认知轨迹改善，而45%的患者轨迹保持不变。此外，5例患者（10%）在VPH后出现新的严重缺陷或认知加速衰退。首次VPH后14例患者（29%）发生手术并发症；4例被归类为短暂性，在随访期间无需手术干预即可缓解。非短暂性并发症包括8例需要手术治疗的脑积水、1例分流的硬膜下积液和1例伤口脑脊液漏。6例患者发生尿崩症，均自发缓解。16例患者存在残留连接，主要位于颞叶内侧区域。7例患者尽管存在可见的残留连接仍无癫痫发作。
VPH是治疗耐药性半球癫痫的一种高效方法，可实现持久的无癫痫发作，且通常具有良好的认知结果。除脑积水外，尿崩症是VPH后的常见并发症。不完全离断不一定会妨碍无癫痫发作。
