Lateral versus vertical hemispheric disconnection for epilepsy: a systematic review and meta-analysis

Massimo Cossu MD1, Michele Nichelatti PhD2, Alessandro De Benedictis MD, PhD3, Michele Rizzi MD1, and on behalf of the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE)
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  • 1 “Claudio Munari” Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy;
  • | 2 Service of Biostatistics, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano, Niguarda, Milan, Italy; and
  • | 3 Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children Hospital IRCCS, Rome, Italy
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OBJECTIVE

Lateral periinsular hemispherotomy (LPH) and vertical parasagittal hemispherotomy (VPH) are the most popular disconnective techniques for intractable epilepsies associated with unilateral hemispheric pathologies. The authors aimed to investigate possible differences in seizure outcome and complication rates between patients who underwent LPH and VPH.

METHODS

A comprehensive literature search of PubMed and Embase identified English-language articles published from database inception to December 2019 that reported series (minimum 12 patients with follow-up ≥ 12 months) on either LPH or VPH. Pooled rates of seizure freedom and complications (with a particular focus on hydrocephalus) were analyzed using meta-analysis to calculate both fixed and random effects. Heterogeneity (Cochran’s Q test) and inconsistency (fraction of Q due to actual heterogeneity) were also calculated.

RESULTS

Twenty-five studies were included. Data from 825 patients were available for seizure outcome analysis (583 underwent LPH and 242 underwent VPH), and data from 692 patients were available for complication analysis (453 underwent LPH and 239 underwent VPH). No differences were found in the pooled rates of Engel class I seizure outcome between patients who underwent LPH (80.02% and 79.44% with fixed and random effects, respectively) and VPH (79.89% and 80.69% with fixed and random effects, respectively) (p = 0.953). No differences were observed in the pooled rates of shunted hydrocephalus between patients who underwent LPH (11.34% and 10.63% with fixed and random effects, respectively) and VPH (11.07% and 9.98% with fixed and random effects, respectively) (p = 0.898). Significant heterogeneity and moderate inconsistency were determined for hydrocephalus occurrence in patients who underwent both LPH and VPH.

CONCLUSIONS

LPH and VPH techniques present similar excellent seizure outcomes, with comparable and acceptable safety profiles.

ABBREVIATIONS

LPH = lateral periinsular hemispherotomy; NOS = Newcastle-Ottawa Scale; VPH = vertical parasagittal hemispherotomy.

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