医学
断开
胼胝体
癫痫
半球切除术
回顾性队列研究
癫痫外科
脑积水
外科
解剖
政治学
精神科
法学
作者
Martin Pilioneta,Hsin-Hung Chen,Emma Losito,Marie Bourgeois,Nicole Chémaly,Monika Eiserman,Lelio Guida,Volodia Dangouloff‐Ros,Luca Fumagalli,Anna Kamińska,Nathalie Boddaert,Stéphane Auvin,Rima Nabbout,Christian Sainte‐Rose,Thomas Blauwblomme
出处
期刊:Operative Neurosurgery
[Oxford University Press]
日期:2023-11-23
被引量:1
标识
DOI:10.1227/ons.0000000000000992
摘要
BACKGROUND AND OBJECTIVES: When seizure onset affects a whole hemisphere, hemispheric disconnections are efficient and safe procedures. However, both lateral peri-insular hemispherotomy and vertical paramedian hemispherotomy approaches report a failure rate around 20%, which can be explained by residual connections giving rise to persistent seizures. In this study, we present the interhemispheric vertical hemispherotomy (IVH), a technical variation of the vertical paramedian hemispherotomy approach, that aims to increase seizure control avoiding residual connections while exposing the corpus callosum. METHODS: This is a retrospective study of IVH in two centers, with analysis of clinical and MRI data and outcomes. A detailed description of the technique is provided with a video. RESULTS: IVH was performed in 39 children. The mean age at surgery was 7.2 years, and etiologies were as follows: malformations of cortical development (n = 14), Rasmussen's encephalitis (n = 10), stroke (n = 10), post-traumatic (3), and Sturge-Weber Syndrome (2). Hemispheric disconnection was complete on postoperative MRI in 34 cases. There was no mortality, hydrocephalus occurred in one case, and subdural collection occurred in four cases. A second surgery was performed in four cases because of seizure relapse (n = 3) and/or incomplete disconnection on MRI (n = 4). With a mean follow-up of 3.2 years, International League Against Epilepsy class I epilepsy outcome was obtained for 37/39 patients. CONCLUSION: IVH is a safe and effective variation of the vertical approaches for hemispheric disconnection. It allows a good exposure and anatomic control of the corpus callosum, which is a frequent site of incomplete disconnection. IVH may be limited by the thalamic volume and the ventricular size, notably in hemimegalencephaly cases.
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