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Disconnective Approach Leads to Superior Seizure Outcome Compared to Other Hemispheric Procedures—A Meta‐Analysis.

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Title: Disconnective Approach Leads to Superior Seizure Outcome Compared to Other Hemispheric Procedures—A Meta‐Analysis.
Authors: Puhahn-Schmeiser, Barbara (AUTHOR), Höller, Yvonne (AUTHOR), Hofe, Franziska vom (AUTHOR), Zentner, Josef (AUTHOR), Jacobs, Julia (AUTHOR), Klotz, Kerstin Alexandra (AUTHOR), Rouhl, Rob (AUTHOR)
Source: Acta Neurologica Scandinavica. 4/8/2025, Vol. 2025, p1-15. 15p.
Subjects: Seizures (Medicine), Epilepsy surgery, Treatment effectiveness, Hemispherectomy, Operative surgery, Surgical excision
Abstract: Hemispherectomy is the most promising treatment for patients with severe hemispheric intractable epilepsy. Several techniques for this surgical intervention have been established, but the choice of technique is currently mostly dependent on the surgeon's experience with a specific approach. We aim to demonstrate whether the choice of the surgical technique moderates surgical outcome in patients with severe hemispheric intractable epilepsy, as measured by seizure freedom and the incidence of death after surgery. We extracted 2382 articles from PubMed and Cochrane. Two independent experts selected 555 articles. We performed a meta‐analysis for all studies and a pooled data analysis for studies where information on individual patients was available. None of the retrieved studies was randomized. Disconnective surgery yielded significantly higher rates of seizure freedom (0.83) than resective (0.70, p < 0.001) or combined surgery (0.64, p < 0.001) for patients with at least 1 year follow–up (N cases = 1165). For death (N cases = 1197), resective surgery had the highest rate of death within a year (0.07), significantly higher than disconnective surgery (0.012, p = 0.001) and combined surgical techniques (0.006, p < 0.001). The assessed techniques did not systematically differ in rate of acute complications, but in their type, for example, acute neurological complications were most common after disconnective surgery (p < 0.001), unspecific symptoms after resective surgery (p < 0.004). Chronic neurological complications were most common after resective surgery (p < 0.001). Seizure freedom is more likely following disconnective surgery as compared to resective or combined techniques. Disconnective and combined surgical techniques lead to fewer chronic complications and death than resective approaches. [ABSTRACT FROM AUTHOR]
Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Label: Title
  Group: Ti
  Data: Disconnective Approach Leads to Superior Seizure Outcome Compared to Other Hemispheric Procedures—A Meta‐Analysis.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Puhahn-Schmeiser%2C+Barbara%22&quot;&gt;Puhahn-Schmeiser, Barbara&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22H&#246;ller%2C+Yvonne%22&quot;&gt;H&#246;ller, Yvonne&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hofe%2C+Franziska+vom%22&quot;&gt;Hofe, Franziska vom&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Zentner%2C+Josef%22&quot;&gt;Zentner, Josef&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Jacobs%2C+Julia%22&quot;&gt;Jacobs, Julia&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Klotz%2C+Kerstin+Alexandra%22&quot;&gt;Klotz, Kerstin Alexandra&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Rouhl%2C+Rob%22&quot;&gt;Rouhl, Rob&lt;/searchLink&gt; (AUTHOR)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Acta+Neurologica+Scandinavica%22&quot;&gt;Acta Neurologica Scandinavica&lt;/searchLink&gt;. 4/8/2025, Vol. 2025, p1-15. 15p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Seizures+%28Medicine%29%22&quot;&gt;Seizures (Medicine)&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Epilepsy+surgery%22&quot;&gt;Epilepsy surgery&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Treatment+effectiveness%22&quot;&gt;Treatment effectiveness&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Hemispherectomy%22&quot;&gt;Hemispherectomy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Operative+surgery%22&quot;&gt;Operative surgery&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Surgical+excision%22&quot;&gt;Surgical excision&lt;/searchLink&gt;
– Name: Abstract
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  Group: Ab
  Data: Hemispherectomy is the most promising treatment for patients with severe hemispheric intractable epilepsy. Several techniques for this surgical intervention have been established, but the choice of technique is currently mostly dependent on the surgeon&#39;s experience with a specific approach. We aim to demonstrate whether the choice of the surgical technique moderates surgical outcome in patients with severe hemispheric intractable epilepsy, as measured by seizure freedom and the incidence of death after surgery. We extracted 2382 articles from PubMed and Cochrane. Two independent experts selected 555 articles. We performed a meta‐analysis for all studies and a pooled data analysis for studies where information on individual patients was available. None of the retrieved studies was randomized. Disconnective surgery yielded significantly higher rates of seizure freedom (0.83) than resective (0.70, p &lt; 0.001) or combined surgery (0.64, p &lt; 0.001) for patients with at least 1 year follow–up (N cases = 1165). For death (N cases = 1197), resective surgery had the highest rate of death within a year (0.07), significantly higher than disconnective surgery (0.012, p = 0.001) and combined surgical techniques (0.006, p &lt; 0.001). The assessed techniques did not systematically differ in rate of acute complications, but in their type, for example, acute neurological complications were most common after disconnective surgery (p &lt; 0.001), unspecific symptoms after resective surgery (p &lt; 0.004). Chronic neurological complications were most common after resective surgery (p &lt; 0.001). Seizure freedom is more likely following disconnective surgery as compared to resective or combined techniques. Disconnective and combined surgical techniques lead to fewer chronic complications and death than resective approaches. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: &lt;i&gt;Copyright of Acta Neurologica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1155/ane/3453458
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 1
    Subjects:
      – SubjectFull: Seizures (Medicine)
        Type: general
      – SubjectFull: Epilepsy surgery
        Type: general
      – SubjectFull: Treatment effectiveness
        Type: general
      – SubjectFull: Hemispherectomy
        Type: general
      – SubjectFull: Operative surgery
        Type: general
      – SubjectFull: Surgical excision
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    Titles:
      – TitleFull: Disconnective Approach Leads to Superior Seizure Outcome Compared to Other Hemispheric Procedures—A Meta‐Analysis.
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            NameFull: Puhahn-Schmeiser, Barbara
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            NameFull: Höller, Yvonne
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            NameFull: Hofe, Franziska vom
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            NameFull: Jacobs, Julia
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            NameFull: Klotz, Kerstin Alexandra
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            – D: 08
              M: 04
              Text: 4/8/2025
              Type: published
              Y: 2025
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