Aventricular hemispherotomy: technical note.

Area of Science:

• Neurosurgery
• Epilepsy Surgery
• Pediatric Neurology

Background:

• Intractable hemispheric epilepsy is best treated with hemispherectomy or hemispherotomy.
• Anatomical hemispherectomy is associated with significant risks, leading to a preference for tissue-sparing hemispherotomy techniques.
• Disconnective hemispherotomies typically rely on the lateral ventricle for surgical access, posing challenges in its absence.

Purpose of the Study:

• To present a novel surgical technique for treating hemispheric dysplasia in a patient lacking a lateral ventricle.
• To demonstrate a purely disconnective, tissue-sparing hemispherotomy approach in an 'aventricular' setting.
• To report the surgical outcome of this innovative procedure.

Main Methods:

• A novel surgical technique for a prone, occipital interhemispheric, tissue-sparing, purely disconnective hemispherotomy was developed.
• The technique was applied to a patient with severe hemispheric dysplasia and absent ipsilateral lateral ventricle.
• Surgical corridor was established without reliance on the lateral ventricle.

Main Results:

• The described surgical technique allowed for a purely disconnective hemispherotomy in the absence of a lateral ventricle.
• The procedure achieved an excellent surgical outcome.
• This approach offers a viable alternative to hemispherectomy in challenging anatomical situations.

Conclusions:

• A purely disconnective, tissue-sparing hemispherotomy is feasible even in the absence of a lateral ventricle.
• This novel surgical technique expands treatment options for intractable hemispheric epilepsy with complex anatomical variations.
• The described method provides a safe and effective alternative to hemispherectomy, potentially reducing associated complications.