Completion Posterior Quadrant Disconnection After Failed Temporal Lobectomy: 2-Dimensional Operative Video

Area of Science:

• Neurosurgery
• Epileptology
• Neurology

Background:

• Epilepsy affects 1% of the global population, with medically refractory epilepsy (MRE) occurring when antiseizure medicines (ASMs) fail.
• Posterior quadrant disconnection (PQD) is an effective surgical treatment for MRE localized to the temporal, parietal, and/or occipital lobes.

Purpose of the Study:

• To demonstrate the technical nuances of a right-sided completion PQD in a pediatric patient with focal MRE.
• To highlight PQD as a viable treatment option for MRE, even after prior failed surgical interventions.

Main Methods:

• The study details a right-sided posterior quadrant disconnection (PQD) in an 8-year-old female with medically refractory epilepsy (MRE).
• Technical steps included revising the scalp incision, using a subdural strip to identify the central sulcus, disconnecting the parietal and occipital lobes, extending the corticectomy, and performing a posterior corpus callosum disconnection.
• Postoperative management involved monitoring for complications and cerebrospinal fluid (CSF) drainage via an external ventricular drain (EVD).

Main Results:

• The patient experienced transient left-arm weakness and central fever, which resolved postoperatively.
• Cerebrospinal fluid (CSF) drainage via external ventricular drain (EVD) cleared within 3-4 days.
• At 3-month follow-up, the patient remained seizure-free with no complications.

Conclusions:

• Posterior quadrant disconnection (PQD) is a safe and effective surgical treatment for medically refractory epilepsy (MRE).
• PQD can be considered as an initial surgical approach or as a salvage procedure following previous failed surgeries.
• This technique offers a potential pathway to seizure freedom for patients with specific types of refractory epilepsy.