Hemispherectomy is highly effective for patients with medically refractory epilepsy (MRE) arising from a single hemisphere. Recently, the Hemispherectomy Outcome Prediction Scale (HOPS) was developed as a prediction tool for seizure freedom after hemispherectomy. The authors’ goal was to perform a validation study to determine the generalizability of the HOPS score.
The authors present an observational, retrospective, 20-year, single-institution, two-surgeon experience using the lateral peri-insular hemispherectomy approach to validate the HOPS score. Variables used to derive the HOPS score included seizure onset age, semiology, PET hypometabolism, seizure substrate, and history of prior epilepsy resection. Multivariable logistic regression, multiple imputation, and Bayesian analyses were used to determine validity.
The authors’ cohort comprised 60 patients; 55% of patients were male and 78% were Caucasian. The median age at first hemispherectomy surgery was 72 months. At 1 year postoperatively, 80% of patients had Engel class I outcomes, analogous to most contemporary series. All patients who experienced seizure recurrence after hemispherectomy did so within the first 2 years postoperatively. Sixteen (27%) and 10 (17%) patients had contralateral MRI findings and hypometabolism on PET, respectively. Both a multivariable logistic regression model using HOPS score variables (model p = 0.2588) and a revised model that included contralateral MRI findings (model p = 0.4715) were not statistically significant in this cohort. Bayesian analysis also did not validate the HOPS score.
While seizure outcome prediction tools may be helpful for counseling patients about postoperative outcomes, rigorous validity and reliability testing are required. Prospective, standardized, and longitudinal evaluation of patients undergoing hemispherectomy are needed.
INCLUDE WHEN CITINGPublished online July 21, 2023; DOI: 10.3171/2023.5.PEDS2391.
DisclosuresDr. Hale reported nonfinancial support from Balt and Medtronic; grants from The Aneurysm and AVM Foundation, Joe Niekro Foundation, Kaul Pediatric Research Institute at Children’s of Alabama, Robert J. Dempsey, MD AANS/CNS Cerebrovascular Research Award, and Center for Clinical and Translational Sciences, University of Alabama at Birmingham outside the submitted work. Research reported in this publication was supported in part by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R25NS079188 (to D.E.O.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This study was also completed while D.E.O. was a Cornwall Clinical Scholar supported by the University of Alabama at Birmingham.
DandyWE.Removal of right cerebral hemisphere for certain tumors with hemiplegia: preliminary report.J Am Med Assoc.1928;90(11):823–825.
SchrammJ,BehrensE,EntzianW.Hemispherical deafferentation: an alternative to functional hemispherectomy.开云体育app官方网站下载入口.1995;36(3):509–516.
VillemureJG,MascottCR.Peri-insular hemispherotomy: surgical principles and anatomy.开云体育app官方网站下载入口.1995;37(5):975–981.
PeacockWJ,Wehby-GrantMC,ShieldsWD,et al.Hemispherectomy for intractable seizures in children: a report of 58 cases.Childs Nerv Syst.1996;12(7):376–384.
GriessenauerCJ,SalamS,HendrixP,et al.Hemispherectomy for treatment of refractory epilepsy in the pediatric age group: a systematic review.J Neurosurg Pediatr.2015;15(1):34–44.
VillemureJG.Anatomical to functional hemispherectomy from Krynauw to Rasmussen.Epilepsy Res Suppl.1992;5:209–215.
DanielpourM,von KochCS,OjemannSG,PeacockWJ.Disconnective hemispherectomy.Pediatr Neurosurg.2001;35(4):169–172.
VillemureJG,DanielRT.Peri-insular hemispherotomy in paediatric epilepsy.Childs Nerv Syst.2006;22(8):967–981.
YoungCC,WilliamsJR,FerozeAH,et al.Pediatric functional hemispherectomy: operative techniques and complication avoidance.Neurosurg Focus.2020;48(4):E9.
TomyczL,HaleAT,AbdulrazeqHF,NaftelRP,EnglotDJ,SegalE.An algorithmic approach to preoperative studies and patient selection for hemispheric disconnection surgery: a literature review.Epileptic Disord.2020;22(5):592–609.
HuWH,ZhangC,ZhangK,ShaoXQ,ZhangJG.Hemispheric surgery for refractory epilepsy: a systematic review and meta-analysis with emphasis on seizure predictors and outcomes.J Neurosurg.2016;124(4):952–961.
LimbrickDD,NarayanP,PowersAK,et al.Hemispherotomy: efficacy and analysis of seizure recurrence.J Neurosurg Pediatr.2009;4(4):323–332.
MillerV,PalermoTM,GreweSD.儿科epileps的生活质量y: demographic and disease-related predictors and comparison with healthy controls.Epilepsy Behav.2003;4(1):36–42.
MoosaAN,GuptaA,JehiL,et al.Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children.Neurology.2013;80(3):253–260.
RamantaniG,KadishNE,BrandtA,et al.Seizure control and developmental trajectories after hemispherotomy for refractory epilepsy in childhood and adolescence.Epilepsia.2013;54(6):1046–1055.
WeilAG,FallahA,WangS,et al.Functional hemispherectomy: can preoperative imaging predict outcome?J Neurosurg Pediatr.2020;25(6):567–573.
WeilAG,LewisEC,IbrahimGM,et al.Hemispherectomy Outcome Prediction Scale: development and validation of a seizure freedom prediction tool.Epilepsia.2021;62(5):1064–1073.
WyllieE,LachhwaniDK,GuptaA,et al.Successful surgery for epilepsy due to early brain lesions despite generalized EEG findings.Neurology.2007;69(4):389–397.
CollinsGS,ReitsmaJB,AltmanDG,MoonsKG.Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD statement.Ann Intern Med.2015;162(1):55–63.
BeesleyLJ,BondarenkoI,ElliotMR,KurianAW,KatzSJ,TaylorJM.Multiple imputation with missing data indicators.Stat Methods Med Res.2021;30(12):2685–2700.
SchaferJL.Analysis of Incomplete Multivariate Data.CRC Press;1997.
WhiteIR,RoystonP,WoodAM.Multiple imputation using chained equations: issues and guidance for practice.Stat Med.2011;30(4):377–399.
GeyerCJ.Practical Markov chain Monte Carlo.Stat Sci.1992;7(4):473–483.
DepaoliS,van de SchootR.Improving transparency and replication in Bayesian statistics: the WAMBS-Checklist.Psychol Methods.2017;22(2):240–261.
LaptookAR,ShankaranS,TysonJE,et al.Effect of therapeutic hypothermia initiated after 6 hours of age on death or disability among newborns with hypoxic-ischemic encephalopathy: a randomized clinical trial.JAMA.2017;318(16):1550–1560.
PedrozaC,HanW,TruongVTT,GreenC,TysonJE.Performance of informative priors skeptical of large treatment effects in clinical trials: a simulation study.Stat Methods Med Res.2018;27(1):79–96.
GelmanA,RubinDB.Inference from iterative simulation using multiple sequences.Stat Sci.1992;7(4):457–472.
BrooksSP,GelmanA.General methods for monitoring convergence of iterative simulations.J Comput Graph Stat.1998;7(4):434–455.
KestleJ,ConnollyM,CochraneD.Pediatric peri-insular hemispherotomy.Pediatr Neurosurg.2000;32(1):44–47.
Terra-BustamanteVC,InuzukaLM,FernandesRM,et al.Outcome of hemispheric surgeries for refractory epilepsy in pediatric patients.Childs Nerv Syst.2007;23(3):321–326.
HaleAT,ChariA,ScottRC,et al.Expedited epilepsy surgery prior to drug resistance in children: a frontier worth crossing?Brain.2022;145(11):3755–3762.
Traub-WeidingerT,WeidingerP,GröppelG,et al.Presurgical evaluation of pediatric epilepsy patients prior to hemispherotomy: the prognostic value of 18F-FDG PET.J Neurosurg Pediatr.2016;25(6):683–688.
ChisolmPF,WarnerJD,HaleAT,et al.Quantifying and reporting outcome measures in pediatric epilepsy surgery: a systematic review.Epilepsia.2022;63(11):2754–2781.
De RibaupierreS,DelalandeO.Hemispherotomy and other disconnective techniques.Neurosurg Focus.2008;25(3):E14.
BaumgartnerJE,BlountJP,BlauwblommeT,ChandraPS.Technical descriptions of four hemispherectomy approaches: from the Pediatric Epilepsy Surgery Meeting at Gothenburg 2014.Epilepsia.2017;58(suppl 1):46–55.
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