Dysphagia after pediatric functional hemispherectomy

Clinical article

Robert T. Buckley M.D.1, Tiffany Morgan M.S., C.C.C.-S.L.P.3, Russell P. Saneto D.O., Ph.D.2,4, Jason Barber M.S.1, Richard G. Ellenbogen M.D.1, and Jeffrey G. Ojemann M.D.1
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  • 1 Departments of Neurological Surgery,
  • | 2 Pediatrics, and
  • | 3 Rehabilitation Medicine; and
  • | 4 Division of Pediatric Neurology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
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Object

Functional hemispherectomy is a well-recognized surgical option for the treatment of unihemispheric medically intractable epilepsy. While the resultant motor deficits are a well-known and expected consequence of the procedure, the impact on other cortical functions has been less well defined. As the cortical control of swallowing would appear to be threatened after hemispherectomy, the authors retrospectively studied a pediatric population that underwent functional hemispherectomy for medically intractable epilepsy to characterize the incidence and severity of dysphagia after surgery.

Methods

A retrospective cohort (n = 39) of pediatric patients who underwent hemispherectomy at a single institution was identified, and available clinical records were reviewed. Additionally, the authors examined available MR images for integrity of the thalamus and basal ganglia before and after hemispherectomy. Clinical and video fluoroscopic assessments of speech pathology were reviewed, and the presence, type, and duration of pre- and postoperative dysphagia were recorded.

Results

New-onset, transient dysphagia occurred in 26% of patients after hemispherectomy along with worsening of preexisting dysphagia noted in an additional 15%. Clinical symptoms lasted a median of 19 days. Increased duration of symptoms was seen with late (> 14 days postoperative) pharyngeal swallow dysfunction when compared with oral dysphagia alone. Neonatal stroke as a cause for seizures decreased the likelihood of postoperative dysphagia. There was no association with seizure freedom or postoperative hydrocephalus.

Conclusions

New-onset dysphagia is a frequent and clinically significant consequence of hemispherectomy for intractable epilepsy in pediatric patients. This dysphagia was always self-limited except in those patients in whom preexisting dysphagia was noted.

Abbreviations used in this paper:

CSE = clinical swallow evaluation; VFSS = videofluoroscopic swallow study.

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