Modification of vertical hemispherotomy for refractory epilepsy

Area of Science:

• Neurosurgery
• Pediatric Neurosurgery
• Epilepsy Surgery

Background:

• Hemispherectomy is a radical epilepsy surgery involving significant brain resection.
• Delalande's vertical hemispherotomy offers a less invasive alternative by minimizing resection.
• Refinements are needed to further optimize the procedure for reduced invasiveness and improved outcomes.

Purpose of the Study:

• To report a modified vertical hemispherotomy technique.
• To reduce brain resection volume compared to the original procedure.
• To enhance confirmation of complete hemispheric disconnection.

Main Methods:

• Modified Delalande's vertical hemispherotomy using an interhemispheric route.
• Defined a new anterior disconnection plane connecting the choroidal fissure to the foramen of Monro.
• Applied the modified technique to 7 patients (4 children, 3 adults) with intractable epilepsy.

Main Results:

• The modified surgery was completed without complications in all 7 cases.
• No patient required cerebrospinal fluid (CSF) shunting post-surgery.
• Excellent seizure control (Engel class I) was achieved in 6 out of 7 patients.
• Postoperative MRI confirmed complete disconnection of the affected hemisphere in all cases.

Conclusions:

• The modified vertical hemispherotomy technique further minimizes brain resection.
• This approach may lead to less invasive surgery and improved disconnection confirmation.
• The technique shows promise for managing severe hemispheric epilepsy in both pediatric and adult populations.