Vertical extraventricular functional hemispherotomy: a new variant for hemispheric disconnection. Technical notes and results in three patients

Flavio Giordano, Barbara Spacca, Carmen Barba, Francesco Mari, Tiziana Pisano, Renzo Guerrini, Lorenzo Genitori

Research output: Contribution to journalArticle

Abstract

Purpose: Hemispherectomy and disconnective hemispherotomy are the most effective epilepsy surgical procedures for the treatment of epilepsy due to hemispheric pathologies such as Sturge-Weber syndrome, diffuse hemispheric cortical dysplasia, and posttraumatic and postischemic focal lesions. Disconnective hemispherotomy is nowadays preferred to reduce surgical morbidity in term of early and late complications (i.e., cerebral superficial hemosiderosis). Despite the number of existing technical variants conceived to further reduce the amount of brain tissue to be removed, postoperative hydrocephalus still persists and may account for an average incidence of 15–41 % according to different series and reviews. A new variant of disconnective vertical hemispherotomy we termed vertical extraventricular parasagittal hemispherotomy is described aiming to further reduce the amount of removed brain tissue and so the risk of postoperative hydrocephalus in favor of a pure hemispheric disconnection. Methods: Three patients affected by drug-resistant epilepsy due to different hemispheric pathologies (posttraumatic epilepsy, Sturge-Weber syndrome, diffuse hemispheric cortical dysplasia) were considered to be candidates for vertical extraventricular parasagittal hemispherotomy disconnective based on presurgical evaluation protocol. The oldest patient was 15 years old, the two youngest were both 2 years old. Results: None of the patients experienced early and late surgical complications. After a mean follow-up of 36 months (range 12–60 months), two patients were seizure free, one relapsed seizures 18 months later. Postoperative hydrocephalus never occurred. Conclusion: Vertical extraventricular parasagittal hemispherotomy may be an efficacious and less invasive technique as it consists in a pure disconnection of the hemisphere with less amount of brain tissue removed and a theoretical reduced risk of postoperative hydrocephalus.

Original languageEnglish
Pages (from-to)2151-2160
Number of pages10
JournalChild's Nervous System
Volume31
Issue number11
DOIs
Publication statusPublished - Nov 1 2015

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Keywords

  • Epilepsy surgery
  • Hemispherectomy
  • Hemispherotomy disconnective technique
  • Hydrocephalus
  • Pediatric epilepsy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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