Managing drug-resistant epilepsy (DRE) in pediatric oncology survivors remains a significant clinical challenge. Recently, surgeons utilized hemispherotomy for ATRT epilepsy to address frequent seizures in a 6-year-old boy. This patient previously underwent treatment for a large left thalamic atypical teratoid rhabdoid tumor (ATRT). Consequently, he developed refractory tonic seizures that significantly impaired his quality of life.

Benefits of Hemispherotomy for ATRT Epilepsy

The patient's initial treatment included subtotal resection, chemotherapy, and radiation. However, two years later, he experienced frequent seizures despite multiple antiseizure medications. Clinical evaluation revealed seizure onset in the left hemisphere along with hypometabolism. Because the child already had right-sided hemiparesis and hemifield neglect, the surgical team prioritized seizure control. Therefore, they performed a left peri-insular hemispherotomy.

Following the surgery, the patient remained seizure-free without any worsening of his neurological function. This case illustrates that aggressive surgical interventions can benefit patients with unilateral disease and preexisting deficits. Furthermore, early surgical evaluation is vital when medication fails to control epilepsy in brain tumor survivors. Clinicians should always weigh surgical risks against the patient's functional baseline to achieve the best outcomes.

Frequently Asked Questions

What is the success rate of hemispherotomy in tumor-related epilepsy?

While data on ATRT specifically is rare, hemispherotomy generally provides excellent seizure control in children with unilateral hemispheric pathology. Many patients achieve complete seizure freedom even after high-grade tumor treatment.

Are neurological deficits expected to worsen after hemispherotomy?

If a child already has a dense motor deficit or hemianopia from a previous tumor or surgery, a hemispherotomy often does not significantly worsen their functional baseline. The goal is to trade a non-functional hemisphere for improved seizure control.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a patient-physician relationship. Refer to the latest local and national guidelines for clinical practice.

References

Hect JL et al. Hemispherotomy for atypical teratoid rhabdoid tumor-associated drug-resistant epilepsy: illustrative case. J Neurosurg Case Lessons. 2026 Apr 13. doi: undefined. PMID: 41974062.

Lersch R et al. Seizure outcomes following epilepsy surgery in pediatric and young adult patients with high-grade brain tumors: Results from a European survey. Epilepsia. 2025 Mar 01. doi: 10.1111/epi.18065.

National Institute of Neurological Disorders and Stroke. Epilepsy Information Page. Available at: https://www.ninds.nih.gov/health-information/disorders/epilepsy.