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Hemispheric surgery in children: perisylvian technique
Helio Rubens Machado1, Marcelo Volpon Santos1
1Department of Surgery and Anatomy, Division of Pediatric Neurosurgery, Center for Epilepsy Surgery in Children, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Insights
Pediatric hemispheric epilepsy often requires surgery due to drug resistance. Functional hemispherotomy is a preferred surgical technique, offering similar outcomes to anatomical hemispherectomy but with fewer complications.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Neurology
Background:
- Hemispheric epilepsy is common in children, with diverse underlying causes like hemimegalencephaly and Rasmussen encephalitis.
- Many pediatric patients with hemispheric epilepsy develop pharmacoresistant seizures, necessitating surgical intervention.
- Surgical options include anatomical hemispherectomy and functional hemispherotomy.
Purpose of the Study:
- To detail the surgical aspects of the perisylvian functional hemispherotomy technique.
- To emphasize the importance of functional hemispherotomy for pediatric epilepsy neurosurgeons.
Main Methods:
- The video presents a detailed surgical description of the perisylvian hemispherotomy.
- Focuses on the practical application and technical nuances of the procedure.
Main Results:
- Functional hemispherotomy demonstrates equivalent outcomes to anatomical hemispherectomy.
- Functional hemispherotomy is associated with fewer postoperative complications compared to anatomical hemispherectomy.
Conclusions:
- Functional hemispherotomy is the favored surgical approach for hemispheric epilepsy in pediatric patients globally.
- Familiarity with functional hemispherotomy techniques is crucial for pediatric epilepsy neurosurgeons to manage pharmacoresistant cases effectively.
Abstract:
Hemispheric epilepsy is quite frequent in children, compared with adults, and encompasses pathological substrates as diverse as hemimegalencephaly, Rasmussen encephalitis, Sturge-Weber syndrome, and porencephaly, among others. These patients most often become pharmacoresistant and thus require surgical management. Although anatomical hemispherectomy is a possibility, the technique that is favored by most epilepsy surgery centers worldwide is functional hemispherotomy, which results in equivalent outcomes with fewer postoperative complications. Therefore, it is essential that pediatric epilepsy neurosurgeons become familiar with these techniques. The present video describes in detail all surgical aspects of the perisylvian hemispherotomy.
