To identify pediatric hemispheric surgery's functional outcomes.

Pediatric hemispheric surgery effectively treats seizures, but functional outcomes are not well-characterized.

Guardians enrolled pediatric hemispheric surgery patients in the Global Pediatric Epilepsy Registry (n=200, 43% females, 51% left-sided surgery; median seizure onset age <1 year; median surgery age=4yr), reporting pre- and postoperative diagnoses across visual, auditory, endocrine, motor, and cognitive domains. McNemar's tests compared, pre- versus post-surgery, proportions of patients with at least one diagnosis per domain and with each diagnosis. General linear models evaluated potential predictors of postoperative diagnoses. p-values were Bonferroni-corrected, with significance threshold=0.05.

While pre-surgery, most patients had multiple daily seizures (84%), 86% became seizure-free post-surgery. However, a significant proportion of patients acquired a postoperative diagnosis affecting each vision (94%), movement (86%), cognition (73%), hearing (19%), and endocrine function (12%). Relative to pre-surgery, significantly more patients had each of the following postoperatively (by decreasing postoperative prevalence): hemiplegia, hemianopsia, strabismus, aphasia, specific learning disability, intellectual impairment, dysgraphia, attention deficit disorder, amblyopia, cortical visual impairment, central auditory processing impairment, speech apraxia, autism, scoliosis, anxiety, early precocious puberty, dyscalculia, and generalized anxiety disorder. Notably, none of seizure etiology, resection side, seizure onset age, surgery age, or time from seizure onset to surgery could predict having at least one postoperative diagnosis in any domain or any postoperative diagnosis, except children with later surgery were significantly more likely to have a postoperative neuropsychological diagnosis; only depression was significantly associated with later surgery. Notwithstanding comorbidity, 99% of guardians reported improved patients' quality of life.

Despite seizure treatment and improved quality of life, pediatric hemispheric surgery patients acquire varied postoperative functional deficits, primarily affecting vision, movement, and cognition. Importantly, no clear predictors for functional outcomes were identified, except that later surgery is associated with postoperative neuropsychological impairment. The findings highlight the need for multidisciplinary post-operative surveillance.