Marcelo Budke, Brent R. O'Neill, Lily C. Wong-Kisiel, Anthony C. Wang, Chima O. Oluigbo, Feng-Peng Wang, Daniel Delev, Chi-Hong Tseng, Poodipedi Sarat Chandra, Martha Feucht, Mary B. Connolly, Faisal Al Otaibi, Yi Yao, Manjari Tripathi, Olivia Kola, Noelia Chamorro, Martin N. Stienen, Jiuluan Lin, Walter Hader, John Ragheb, Valentina Baro, Qiang Guo, Aria Fallah, Georgia Ramantani, Jia-Shu Chen, Valeria L. Muro, Matthew D. Smyth, Qingzhu Liu, George M. Ibrahim, Galymzhan Issabekov, Eveline Teresa Hidalgo, Karl Lothard Schaller, William D. Gaillard, Wenjing Zhou, Evan J. H. Lewis, Maria Angeles Pérez-Jiménez, Roy W. R. Dudley, Alexander G. Weil, Tristan Brunette-Clément, Marec von Lehe, Jeffrey Bolton, Jianguo Zhang, William B. Harris, Sanjiv Bhatia, Christian Raftopoulos, Josef Zentner, Shao-Chun Li, Niklaus Krayenbühl, Lixin Cai, Christian Dorfer, Mashael Al-Khateeb, Pierre-Olivier Champagne, Kai Zhang, Thomas Czech, Robert J. Bollo, Silvia Vieker, Pauline Michel, Paul Steinbok, P. Finet, Christian Cantillano Malone, Gary W. Mathern, Howard L. Weiner, Hongwei Zhu, Samuel Lapalme-Remis, Juan Pociecha, Phillip L. Pearl, Kao-Min Lin, UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service de neurochirurgie, and UCL - (SLuc) Centre du cancer
ObjectiveThis study was undertaken to determine whether the vertical parasagittal approach or the lateral peri-insular/peri-Sylvian approach to hemispheric surgery is the superior technique in achieving long-term seizure freedom.MethodsWe conducted a post hoc subgroup analysis of the HOPS (Hemispheric Surgery Outcome Prediction Scale) study, an international, multicenter, retrospective cohort study that identified predictors of seizure freedom through logistic regression modeling. Only patients undergoing vertical parasagittal, lateral peri-insular/peri-Sylvian, or lateral trans-Sylvian hemispherotomy were included in this post hoc analysis. Differences in seizure freedom rates were assessed using a time-to-eventmethod andcalculated using the Kaplan-Meier survival method.ResultsData for 672 participants across 23 centers were collected on the specific hemispherotomy approach. Of these, 72 (10.7%) underwent vertical parasagittalhemispherotomy and 600 (89.3%) underwent lateral peri-insular/peri-Sylvian or trans-Sylvian hemispherotomy. Seizure freedom was obtained in 62.4% (95% confidence interval [CI]=53.5%-70.2%) of the entire cohort at 10-year follow-up. Seizure freedom was 88.8% (95% CI=78.9%-94.3%) at 1-year follow-up and persisted at 85.5% (95% CI=74.7%-92.0%) across 5- and 10-year follow-up in the vertical subgroup. In contrast, seizure freedom decreased from 89.2% (95% CI=86.3%-91.5%) at 1-year to 72.1% (95% CI=66.9%-76.7%) at 5-year to 57.2% (95% CI=46.6%-66.4%) at 10-year follow-up for the lateral subgroup. Log-rank test found that vertical hemispherotomy was associated with durable seizure-free progression compared to the lateral approach (p=.01). Patients undergoing the lateral hemispherotomy technique had a shorter time-to-seizure recurrence (hazard ratio=2.56, 95% CI=1.08-6.04, p=.03) and increased seizure recurrence odds (odds ratio=3.67, 95% CI=1.05-12.86, p=.04) compared to those undergoing the vertical hemispherotomy technique.SignificanceThis pilot study demonstrated more durable seizure freedom of the vertical technique compared to lateral hemispherotomy techniques. Further studies, such as prospective expertise-based observational studies or arandomized clinical trial, are required to determine whether a vertical approach to hemispheric surgery provides superior long-term seizure outcomes.