Clinica Linvestigation That "Subtotal" Hemispherectomy For Treatment Of Hemispheric Epilepsy Syndrome

Objective:To explore the "Subtotal" hemispherectomy in the treatment of hemispheric epilepsy syndrome,which the motor functional was preserved.Methods:A retrospective analysis of 19 patients operated for hemispheric syndrome induced epilepsy,who have been treated by "Subtotal" hemispherectomy from2010 to 2017 in NO.174 Liberation Army Hospital,which included 12 males and 7 females.And the average age was 16.73±8.80 years(range fromlyear 11 months to 34 years),the first seizure average age was5.94±5.70years(range from 1 month to 17 years),the average disease-process of 10.81±8.26 years(range from 1 month ? 33 years).The patients are meet the diagnostic criteria of hemispheric epilepsy syndrome,and the preoperative evaluation of affected hemisphere left motor function.Surgical approach is "Subtotal" hemispherectomy of the functional area was preserved.The operation is monitored with ECoG and DES.We used the epilepsy control rate,preoperative and postoperative neurological function evaluation,neuropsychological assessment and quality of life assessment to evaluate the operation effect.Results:Postoperative follow-up for 3.51±2.05 years(range from 10 months to 7 years).Evaluate the effects for the 18 patients who followed-up at least lyears.Outcomes consisted of class 1,55.6%(n=10);class 3,16.7%(n=2);class 4,22.2%(n=4)and class 5,16.7%(n=2).Postoperative follow-up analysis showed 3 cases(15.8%)achieved improvement in language function,and 5 cases(26.3%)achieved improvement in motor function of contralateral lower extremity and 3 cases(15.8%)who achieved improvement in contralateral hand fine motor.However,2 cases(10.5%)who underwent "Subtotal"hemispherectomy became worse after surgery in motor function of contralateral lower extremity and 4 case(21.1%)in contralateral hand fine motor.1 case(5.3%)became worse in motor function of contralateral lower extremity and hand fine motor.Postoperative IQ(70.08±21.20)is improved with preoperative IQ(57.77±19.63),(P<0.05).QOL(59.13±6.89)improved in postoperative,compared with preoperative(41.20±15.00),(P<0.05).Conclusion:"Subtotal" hemispherectomy is an effective treatment for hemispheric epilepsy syndrome,with who the motor functional was preserved,not only postoperative epileptic seizure free rate was high,but also the patient had better neurological function reserved.Significantly improve the quality of life of epileptics.