Surgical Anatomy and Technique of Peri-Insular Hemispherotomy in Pediatric Epilepsy.
| Autor: | Cicutti SE; Neurosurgery Department, Juan P. Garrahan Hospital, Buenos Aires , Argentina., Cuello JF; Neurosurgery Department, Hospital Provincial Petrona V. de Cordero, San Fernando, Buenos Aires , Argentina., Villamil F; Neurosurgery Department, FLENI, Buenos Aires , Argentina., Gromadzyn GP; Neurosurgery Department, Juan P. Garrahan Hospital, Buenos Aires , Argentina., Bartuluchi M; Neurosurgery Department, Juan P. Garrahan Hospital, Buenos Aires , Argentina. |
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| Jazyk: | angličtina |
| Zdroj: | Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2024 Nov 01; Vol. 27 (5), pp. 608-617. Date of Electronic Publication: 2024 Apr 23. |
| DOI: | 10.1227/ons.0000000000001161 |
| Abstrakt: | Background and Objectives: Hemispherotomy is a highly complex procedure that demands a steep learning curve. An incomplete brain disconnection often results in failure of seizure control. The purpose of this article was to present a step-by-step guide to the surgical anatomy of this procedure. It is composed of a 7-stage approach, enhancing access to and improving visualization of deep structures. Methods: A retrospective analysis of 39 pediatric patients with refractory epilepsy who underwent this technique was conducted. Engel scores were assessed 1 year postsurgery. Cadaveric dissections were performed to illustrate the procedure. Results: Between 2015 and 2022, 39 patients were surgically treated using the peri-insular technique. The technique involved 7 stages: patient positioning, operative approach, opercular resection, transventricular callosotomy, fronto-orbital disconnection, anterior temporal disconnection, and posterior temporal disconnection. Most of the patients (92.30%) were seizure-free (Engel class I) at 1 year postoperative, 5.13% were nearly seizure-free (Engel II), and 2.56% showed significant improvement (Engel III). Complications occurred in 8% of cases, including 1 infection, 2 cases of aseptic meningitis, and 1 non-shunt-requiring acute hydrocephalus. Conclusion: The peri-insular hemispherotomy technique offers excellent seizure control with a low complication rate. Our visual documentation of surgical anatomy, complemented by detailed descriptions of surgical nuances, significantly contributes to a comprehensive understanding of this technique. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.) |
| Databáze: | MEDLINE |
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