• Jeffrey P Mullin, Pranay Soni, Sungho Lee, Lara Jehi, Ahsan Moosa Naduvil Valappi, William Bingaman, and Jorge Gonzalez-Martinez.
• *Department of Neurosurgery, Epilepsy Center, and §Department of Neurology, Section of Pediatric Epilepsy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; ‡Case Western Reserve University Medical School, Cleveland, Ohio.
• Neurosurgery. 2016 Sep 1; 79 (3): 499-507.

BackgroundIn some cases of refractory epilepsy, hemispherectomy is the final invasive treatment option. However, predictors of postoperative hemiparesis in these patients have not been widely studied.ObjectiveTo investigate how the volumetric analysis of cerebral peduncles and cerebellar hemispheres in patients who have undergone hemispherectomy may determine prognostic implications for postoperative hemiparesis.MethodsTwenty-two patients who underwent hemispherectomy at our institution were retrospectively included. Using iPlan/BrainLAB (BrainLAB, Feldkirchen, Germany) imaging software and a semiautomatic voxel-based segmentation method, we calculated the preoperative cerebral peduncle and cerebellar hemisphere volumes. Cerebral peduncle and cerebellar hemisphere ratios were compared between patients with worsened or unchanged/better hemiparesis postoperatively.ResultsThe ratios of ipsilateral/contralateral cerebral peduncles (0.570 vs 0.828; P = .02) and contralateral/ipsilateral cerebellar hemispheres (0.885 vs 1.031; P = .009) were significantly lower in patients who had unchanged/improved hemiparesis postoperatively compared with patients who had worsened hemiparesis. Relative risk of worsening hemiparesis was significantly higher in patients with a cerebral peduncle ratio < 0.7 (relative risk, 4.3; P = .03) or a cerebellar ratio < 1.0 (relative risk, 6.4; P = .006).ConclusionAlthough patients who undergo hemispherectomy are heterogeneous, we report a method of predicting postoperative hemiparesis using only standard volumetric magnetic resonance imaging. This information could be used in preoperative discussions with patients and families to help better understand that chance of retaining baseline motor function.AbbreviationsCST, corticospinal tractfMRI, functional magnetic resonance imagingTMS, transcranial magnetic stimulation.

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