Hemispheric surgery is an established treatment for medically refractory epilepsy due to diffuse hemispheric disease, with 60-80 % of seizure control, besides cognitive, behavioral and psychosocial improvement. Lateralization of linguistic functions, usually in the left hemisphere, is defined by the age of six years. Risk of postoperative aphasia due to dominant hemispheric surgery contributes for not operating children older than this. The aim of this study is to evaluate the speech of children who underwent left hemispherothomy by the time language dominance is theoretically well established.

Retrospective data on 18 patients older than 5 years old who underwent left hemispherothomy between 1998 and 2012, with at least 6 months follow up, were collected. Postoperatively, Engel classification and neurological examination plus Vineland Adaptive Behavior Scale were used for seizure and communication outcomes, respectively.

Ages at surgery were between 5 and 18 years (mean 9.9). Concerning the etiology, 6 (33,3%) presented Rasmussen, 7 (38,9%) acquired causes , 5 (27,8%) malformation of cortical development  at the histopathology.

After a follow-up period from 6 months to 8 years (mean 3.5), 14 patients were re-evaluated for seizures and 10 (71,4 %) were classified as Engel I or II , 4 (28,6%) as III or IV. Regarding communication, postoperatively 17 patients (94,4%) remained unchanged and one presented speech deterioration.

Left hemispherothomy performed in children older than 5 years is associated with good seizure outcome and may not be deleterious on speech function previously acquired.