Language
English
Publication Date
1-1-2026
Journal
Pediatric Neurosurgery
DOI
10.1159/000548718
PMID
41037508
PMCID
PMC13218697
PubMedCentral® Posted Date
10-2-2025
PubMedCentral® Full Text Version
Post-print
Abstract
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 were 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 6 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 were 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 selected 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.
Keywords
Humans, Drug Resistant Epilepsy, Quality of Life, Female, Male, Child, Child, Preschool, Retrospective Studies, Treatment Outcome, Hemispherectomy, Adolescent, Panama, Resource-Limited Settings, Follow-Up Studies, Epilepsy surgery, Childhood epilepsy, Seizure
Published Open-Access
yes
Recommended Citation
Rhodenhiser, Emmajane G; Bonda, David; Baez, Carmen; et al., "Hemispherotomy for Drug-Resistant Epilepsy in a Low-Resource Setting: Surgical Outcomes and Quality of Life in 23 Children Treated in a Hybrid Program in Panama" (2026). Faculty, Staff and Students Publications. 7328.
https://digitalcommons.library.tmc.edu/baylor_docs/7328