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Published on: September 20, 2024
Peri-insular hemispherotomy in paediatric epilepsy
Jean-Guy Villemure1, Roy Thomas Daniel
1Neurosurgery Service, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland. jean-guy.villemure@chuv.ch
Insights
Peri-insular hemispherotomy (PIH) is an effective surgical treatment for paediatric epilepsy, offering a favorable balance of benefits and complications. This procedure has shown excellent seizure control outcomes in most young patients.
Area of Science:
- Neurosurgery
- Paediatric Neurology
- Epilepsy Surgery
Background:
- Paediatric epilepsy often requires surgical intervention when medical management fails.
- Hemispherectomy is a radical surgical option for intractable epilepsy originating from one hemisphere.
- Peri-insular hemispherotomy (PIH) is a disconnective technique aiming to minimize invasiveness.
Purpose of the Study:
- To detail the indications, investigations, surgical technique, and outcomes of PIH in children.
- To evaluate the complications and benefits associated with PIH.
- To establish PIH as a preferred disconnective hemispherectomy technique.
Main Methods:
- A consecutive series of 43 paediatric patients undergoing PIH was analyzed.
- Data collected included patient demographics, epilepsy history, surgical details, and postoperative outcomes.
- Complications and seizure control (Engel's classification) were meticulously recorded.
Main Results:
- The study included 43 children, with a median of 5 years from seizure onset to surgery.
- Congenital anatomical substrates were present in over half the cases.
- Ninety percent of patients achieved Engel's class I outcome, with a low complication rate including one death.
Conclusions:
- Clear indications exist for hemispherectomy in paediatric epilepsy.
- PIH offers a favorable complications-benefits ratio for disconnective hemispherectomy.
- The timing of surgery remains critical, especially with incomplete neurological deficits.
Objects:
Outline the indications, investigation, surgical technique, pitfalls, complications and benefits of peri-insular hemispherotomy (PIH) in the surgical treatment of paediatric epilepsy.
Materials And Methods:
This report is based on a consecutive series of 43 children who underwent PIH. Sixty percent were males; there were slightly more left-sided surgeries. Median interval between seizure onset and surgery was 5 years. In more than half the cases, the anatomical substrate was congenital. There were few complications: one death, one hydrocephalus and two anatomically remote haemorrhages. Ninety percent of the patients have remained in Engel's class I epilepsy outcome.
Conclusions:
There are clear indications for hemispherectomy in children. In some instances of incomplete deficit, timing of surgery remains a major concern. The less invasive approach to eliminate the influence of the diseased hemisphere, in our opinion, is with disconnective techniques of hemispherectomy, and among the latter, peri-insular hemispherotomy provides, in our opinion, the best complications-benefits ratio.
