Table 2.
Surgical Procedure; Postoperative Seizure, Motor, and Cognitive Outcomes Estimated as the 1-, 2-, and 5-Year Probabilities and at the Last Follow-Up; and Postoperative Complications of the Included Patients With SWS (n = 214)
| Subject | Total (N = 214) | Study group | HS subgroup | |||
| FR (n = 87) | HS (n = 127) | AH (n = 33) | MH (n = 94) | p Value | ||
| Surgical procedure | ||||||
| Side of surgery, n (%) | ||||||
| Left | 100 (46.7) | 42 (48.3) | 58 (45.7) | 15 (25.9) | 43 (74.1) | 0.98 |
| Right | 114 (53.3) | 45 (51.7) | 69 (54.3) | 18 (26.1) | 51 (73.9) | |
| Duration of surgery, min, median (IQR) | 388.0 (300.0–450.0) | 360.0 (280.0–420.0) | 419.0 (310.0–460.2) | 450.0 (414.0–525.0) | 384.0 (270.0–445.3) | <0.001c |
| Blood loss, mL, median (IQR) | 500.0 (295.0–632.5) | 500.0 (260.0–600.0) | 500.0 (300.0–700.0) | 600.0 (375.0–800.0) | 400.0 (237.5–600.8) | 0.003c |
| Blood transfusion, mL, median (IQR) | 570.0 (300.0–752.5) | 525.0 (200.0–700.0) | 600.0 (350.0–840.0) | 825.0 (600.0–1,050.0) | 525.0 (300.0–725.0) | <0.001c |
| Postoperative length of hospital stay, d, median (IQR) | 14.0 (10.0–19.0) | 13.0 (9.0–19.0) | 15.0 (11.0–19.0) | 19.0 (14.5–23.5) | 13.5 (11.0–18.0) | <0.001c |
| Seizure outcomes | ||||||
| Estimated seizure-free probability, % (95% CI)a | ||||||
| 1 y | 86.9 (82.5–91.6) | 83.9 (76.5–92.0) | 89.0 (83.7–94.6) | 93.9 (86.1–100.0) | 87.2 (80.7–94.2) | 0.44 |
| 2 y | 81.4 (76.1–87.1) | 77.8 (69.1–87.6) | 83.9 (77.4–90.9) | 87.5 (76.7–99.8) | 82.7 (75.0–91.2) | |
| 5 y | 70.7 (63.3–79.0) | 61.7 (50.3–75.8) | 78.9 (70.9–87.8) | 83.8 (71.7–97.9) | 76.2 (65.3–88.9) | |
| Last follow-up, n (%) | ||||||
| Seizure-free (Engel class I) | 166 (77.6) | 61 (70.1) | 105 (82.7) | 28 (84.8) | 77 (81.9) | 0.46 |
| Engel class II | 33 (15.4) | 19 (21.8) | 14 (11.0) | 2 (6.1) | 12 (12.8) | |
| Engel class III | 14 (6.5) | 6 (6.9) | 8 (6.3) | 3 (9.1) | 5 (5.3) | |
| Engel class IV | 1 (0.5) | 1 (1.1) | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
| ASM withdrawal | ||||||
| ASM reduction, n (%) | 140 (65.4) | 56 (64.4) | 84 (66.1) | 22 (66.7) | 62 (66.0) | 0.94 |
| Time to reduction, mo, median (IQR) | 16.0 (12.0–24.0) | 24.0 (12.0–24.0) | 14.5 (12.0–24.0) | 24.0 (12.0–24.0) | 12.0 (12.0–24.0) | 0.19 |
| ASM discontinuation, n (%) | 98 (45.8) | 39 (44.8) | 59 (46.5) | 17 (51.5) | 42 (44.7) | 0.50 |
| Time to discontinuation, mo, median (IQR) | 24.0 (24.0–29.3) | 24.0 (24.0–27.0) | 24.0 (24.0–36.0) | 24.0 (24.0–42.0) | 24.0 (24.0–28.5) | 0.49 |
| Motor outcomes | ||||||
| Estimated motor-stable probability, % (95% CI)b | ||||||
| 1 y | 65.4 (58.4–71.2) | 85.1 (75.3–90.9) | 52.0 (42.4–59.9) | 48.5 (28.3–63.0) | 53.2 (41.9–62.3) | 0.37 |
| 2 y | 80.2 (73.8–85.0) | 92.5 (84.1–96.5) | 71.7 (62.3–78.8) | 67.8 (46.7–80.5) | 73.1 (61.8–81.1) | |
| 5 y | 85.7 (79.5–90.1) | 94.4 (85.6–97.8) | 79.8 (70.4–86.2) | 74.2 (53.5–85.7) | 82.3 (70.4–89.4) | |
| Last follow-up, n (%) | ||||||
| Motor-stable | 176 (82.2) | 81 (93.1) | 95 (74.8) | 24 (72.7) | 71 (75.5) | 0.77 |
| Improvement | 70 (32.7) | 8 (9.2) | 62 (48.8) | 17 (51.5) | 45 (47.9) | |
| No change | 106 (49.5) | 73 (83.9) | 33 (26.0) | 7 (21.2) | 26 (27.7) | |
| Worsening | 38 (17.8) | 6 (6.9) | 32 (25.2) | 9 (27.3) | 23 (24.5) | |
| Cognitive outcomes | ||||||
| Estimated cognition-stable probability, % (95% CI)b | ||||||
| 1 y | 80.8 (74.8–85.5) | 88.5 (79.4–93.6) | 75.6 (66.9–82.0) | 66.7 (46.0–79.4) | 78.7 (68.6–85.6) | 0.45 |
| 2 y | 85.1 (79.3–89.2) | 89.9 (80.9–94.7) | 81.7 (73.4–87.4) | 76.7 (56.2–87.6) | 83.4 (73.7–89.5) | |
| 5 y | 89.5 (83.8–93.2) | 92.0 (82.5–96.3) | 87.5 (79.3–92.5) | 86.7 (67.2–94.6) | 86.9 (76.7–92.6) | |
| Last follow-up, n (%) | ||||||
| Cognition stable | 187 (87.4) | 79 (90.8) | 108 (85.0) | 28 (84.8) | 80 (85.1) | 0.999 |
| Improvement | 91 (42.5) | 14 (16.1) | 77 (60.6) | 20 (60.6) | 57 (60.6) | |
| No change | 96 (44.9) | 65 (74.7) | 31 (24.4) | 8 (24.2) | 23 (24.5) | |
| Worsening | 27 (12.6) | 8 (9.2) | 19 (15.0) | 5 (15.2) | 14 (14.9) | |
| Postoperative complications, n (%) | ||||||
| Presence | 25 (11.7) | 13 (14.9) | 12 (9.4) | 6 (18.2) | 6 (6.4) | 0.10 |
| Absence | 189 (88.3) | 74 (85.1) | 115 (90.6) | 27 (81.8) | 88 (93.6) | |
Abbreviations: AH = anatomical hemispherectomy; ASM = antiseizure medication; FR = focal resection; HS = hemisphere surgery; MH = modified hemispherotomy; SWS = Sturge-Weber syndrome.
1-, 2-, and 5-year seizure-free probabilities, motor-stable probabilities, and cognition-stable probabilities were estimated by Kaplan-Meier analysis.
Postoperative neurologic function subcategory motor function and cognitive function were evaluated by the SWS neurologic score by Kelley et al. with the hemiparesis domain and cognition domain of the scale, respectively.
p < 0.01 (Mann-Whitney U test, log-rank test, or Pearson χ2 test, as appropriate).