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Updated: Aug 6, 2025

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Published on: October 20, 2017

Second surgery after vertical paramedian hemispherotomy for epilepsy recurrence.

Cedric Baltus¹, Bouchra El M'Kaddem², Susana Ferrao Santos³

¹Department of Neurosurgery, University Hospital St-Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200, Brussels, Belgium.

|March 23, 2023

Summary

Incomplete amygdala resection after Vertical Paramedian Hemispherotomy (VPH) can cause epilepsy recurrence. Targeted complementary amygdala resection offers a safe and effective solution for seizure control in these challenging cases.

Keywords:

Amygdala Drug-resistant epilepsy Fail vertical paramedian hemispherotomy Hemispherotomy Paramedian Rasmussen Repeat Vertical

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Published on: April 12, 2024

Area of Science:

Neurosurgery
Epileptology
Pediatric Neurology

Background:

Vertical Paramedian Hemispherotomy (VPH) is a key treatment for drug-resistant epilepsy, achieving success in 80% of patients.
Identifying residual epileptogenic zones after VPH failure presents a diagnostic challenge.

Observation:

Two pediatric cases with recurrent seizures post-hemispherotomy required revision surgery.
Persistent amygdala residue was identified as the likely cause of epilepsy recurrence in both patients.

Findings:

Comprehensive diagnostic tools, including advanced imaging like DTI MRI, are crucial for reassessing failed VPH.
Complementary resection of the residual amygdala successfully achieved seizure freedom (Engel IA/ILAE Class 1) in both patients without complications.

Implications:

Incomplete amygdala resection is a potential cause of persistent epilepsy after VPH.
Targeted, complementary amygdala resection is a viable and safe strategy for managing epilepsy recurrence post-hemispherotomy.