OBJECTIVES – To describe the patient characteristics and outcome (feasibility, safety and effectiveness) of hemispherotomy.

METHODS - A retrospective analysis of 26 patients (under age 18 years) who underwent hemispherotomy by a single comprehensive epilepsy team in a multicentre setting from January 2010 to December 2017 was done. Their clinical course and outcomes were analysed.

RESULTS - A total of 26 patients (14 males) underwent functional hemispherotomy (18 right hemispheric). Mean age at surgery was 7.89 years (range: 4 months to 18 years), mean duration of epilepsy prior to surgery was 4.9 years. The underlying etiologies were: 5 – hemimegalencephaly, 6 – perinatal vascular insult, 5 – hemispheric dysplasia, 2 – Rasmussen encephalitis, 2 – hemiatrophy, 6 – gliosis. Seven cases underwent motor sparing hemispherotomy. Hemispherotomies were performed for emergency seizure control in 4 cases for super refractory status epilepticus. All patients had variable degree of hemiparesis prior to the surgery. Hydrocephalus requiring VP shunt (n=1) and tracheostomy in view of prolonged ventilation (n=2) were the major complications in the post-operative period. Fever and anaemia in the immediate postoperative period were the common minor adverse events noted. Mean duration of follow up was 38.4 months. 23 patients had Engel Class I (20 - IA, 3- IB) and 3 patients had Engel Class II at the last follow up.

CONCLUSION - Hemispherotomy is a feasible, safe and efficacious surgery for seizure control among children and adolescents with drug resistant hemispheric epilepsies of unilateral origin.