• Jeffrey Paul Mullin, Sungho Lee, William E Bingaman, and Jorge Gonzalez.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:230-1.

IntroductionBetter ways to predict motor outcome following hemispherectomy are necessary to implement the informed consent process in patients with hemispheric epilepsy. The volumetric analysis of cerebral peduncles and cerebellar hemispheres in patients who had undergone hemispherectomy may determine prognostic implications for postoperative hemiparesis.MethodsTwenty-two patients who underwent hemispherectomy at our institution, who had follow-up of at least 6 months and had accessible preoperative volumetric MRIs were retrospectively included. With the use of iPlan/BrainLAB imaging software, the volumes of bilateral cerebral peduncles and cerebellar hemispheres were calculated. After defining the borders of region of interest the volume of the resulting enclosed figure was calculated using software iPlan cranial via a semiautomatic voxel-based segmentation method.ResultsEleven patients were found to have improved or unchanged hemiparesis (group 1); these were compared with 11 who had worsening hemiparesis following hemispherectomy (group 2). The ratio of ipsilateral/contralateral peduncle volume in group 1 was 0.535 with a standard deviation of 0.23 (laterality refers to side of hemispherectomy), significantly lower than the ratio in group 2 (0.79 with a standard deviation of 0.21; P value <.0139). No patient with a peduncle ratio of less than 0.5 experienced worsening of hemiparesis.ConclusionWhile patients who undergo hemispherectomy are heterogeneous, we report a method of predicting postoperative hemiparesis only using a standard volumetric MRI. This information could be used in the preoperative discussions with patients and families to help better understand that chance of retaining baseline motor function.

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