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Related Concept Videos

Psychosurgery01:30

Psychosurgery

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Psychosurgery, the surgical alteration or permanent removal of brain tissue to alleviate severe psychological conditions, stands as one of the most radical and controversial treatments in the history of mental health care. Its development and application have evolved significantly, marked by dramatic shifts in scientific understanding and ethical perspectives.
Historical Development of Psychosurgery
In the 1930s, Portuguese neurologist Antonio Egas Moniz introduced a surgical procedure designed...
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Right Hemihepatectomy by Suprahilar Intrahepatic Transection of the Right Hemipedicle using a Vascular Stapler
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Peri-Insular Hemispherotomy: A Systematic Review and Institutional Experience.

Charles F Yates1,2,3, Stephen Malone4,5, Kate Riney3,4

  • 1Department of Neurosurgery, Queensland Children's Hospital, Brisbane, Queensland, Australia.

Pediatric Neurosurgery
|January 24, 2023
PubMed
Summary

Peri-insular hemispherotomy (PIH) offers excellent seizure control for intractable epilepsy, with over 80% achieving Engel class 1 outcomes. Careful assessment is needed for very young patients due to higher hydrocephalus risk.

Keywords:
EpilepsyPaediatric patientPeri-insular hemispherotomy

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Area of Science:

  • Neurosurgery
  • Epilepsy Surgery
  • Pediatric Neurology

Background:

  • Peri-insular hemispherotomy (PIH) is a specific surgical technique for intractable epilepsy.
  • Existing research often groups PIH with other hemispherotomy methods, obscuring its unique outcomes.
  • This study focuses on PIH's patient selection, outcomes, and complications.

Approach:

  • A systematic literature review adhering to PRISMA guidelines was performed.
  • Searches included PubMed and Embase databases.
  • A local case series from Queensland Children's Hospital (2014-2020) was incorporated.

Key Points:

  • The systematic review analyzed 393 patients from 13 studies, showing 82.4% Engel class 1 outcomes.
  • Post-operative hydrocephalus occurred in 8.6% of patients, predominantly in younger cohorts.
  • Patients with developmental pathology had lower Engel 1 outcomes (69.1%) compared to acquired pathology (83.7%).
  • The local series of 13 patients reported 84.6% Engel 1 outcomes, with 15.4% developing hydrocephalus and 76.9% experiencing worsened neurological deficit.

Conclusions:

  • PIH achieves Engel 1 outcomes in over 80% of selected patients, surpassing combined hemispherotomy analyses.
  • The technique is effective for both developmental and acquired pathologies.
  • While beneficial for very young patients, PIH carries a higher risk of hydrocephalus, necessitating careful risk-benefit evaluation.