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Modified Vertical Parasagittal Sub-Insular Hemispherotomy-Case Series and Technical Note.

Nicole Del Gaudio1, Susana Ferrao Santos2, Christian Raftopoulos3

  • 1Neurosurgery Department, University Hospital Saint Luc, Université Catholique de Louvain, Av. Hippocrate 10, 1200 Brussels, Belgium.

Brain Sciences
|October 28, 2023
PubMed
Summary

A modified sub-insular vertical parasagittal hemispherotomy (VPH) offers a successful surgical option for hemispheric drug-resistant epilepsy (DRE). This technique achieves high seizure freedom rates with reduced complications like hydrocephalus.

Keywords:
drug-resistant epilepsyhemispherotomysurgical procedure

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Neurology

Background:

  • Hemispherotomy is a standard treatment for hemispheric drug-resistant epilepsy (DRE).
  • Surgical approaches vary, with vertical parasagittal hemispherotomy (VPH) having several modifications.
  • This study introduces a novel sub-insular variation of VPH.

Purpose of the Study:

  • To evaluate the efficacy and safety of a modified sub-insular VPH technique.
  • To report outcomes in a series of patients with hemispheric DRE treated with this approach.

Main Methods:

  • Retrospective analysis of a consecutive series of patients undergoing modified sub-insular VPH.
  • Data collected included pre-operative characteristics, functional outcomes, and surgical complications.
  • Follow-up data assessed seizure control, motor function, and cognitive outcomes.

Main Results:

  • Twenty-five patients were operated on; 23 had adequate follow-up.
  • Eighty-seven percent (20/23) of patients achieved seizure freedom.
  • Postoperative hydrocephalus occurred in only 8.7% of patients, with excellent long-term motor and cognitive outcomes.

Conclusions:

  • The modified sub-insular VPH is an effective surgical treatment for hemispheric DRE.
  • This technique demonstrates comparable seizure freedom rates to other reported series.
  • It offers a lower incidence of hydrocephalus and excellent functional recovery.