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Salvage Trans-Sylvian Peri-Insular Hemispherotomy After Embolic Hemispherectomy
Michael E Baumgartner1, Sudha Kessler2,3, Kathleen Galligan4
1The Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania USA.
Annals of the Child Neurology Society
|August 7, 2026
Summary
Endovascular hemispherectomy for drug-resistant epilepsy showed limited success, requiring a salvage hemispherotomy. This case suggests endovascular destruction may not effectively replace traditional surgical hemispherectomy or hemispherotomy for treating hemispheric epilepsy.
Area of Science:
- Neurology
- Neurosurgery
- Interventional Neuroradiology
Background:
- Hemispherectomy and hemispherotomy are established treatments for drug-resistant hemispheric epilepsy.
- An alternative endovascular procedure aims to achieve hemispherectomy effects via embolization and infarction.
- The safety and effectiveness of endovascular hemispherectomy remain unestablished.
Purpose of the Study:
- To evaluate the effectiveness of endovascular hemispherectomy in a patient with drug-resistant focal epilepsy and challenging surgical anatomy.
- To assess the outcome of a salvage hemispherotomy after failed endovascular hemispherectomy.
Main Methods:
- A 4-month-old girl with drug-resistant focal epilepsy due to hemimegalecephaly underwent endovascular hemispherectomy.
- Pre-operative MRI revealed viable tissue, prompting a salvage hemispherotomy.
- Intra-operative assessment showed unexpected perfusion of the embolized cortex.
Main Results:
- Endovascular embolization did not achieve complete hemispheric destruction or disconnection.
- The patient continued to experience seizures post-embolization, necessitating a salvage hemispherotomy.
- The patient remained seizure-free at 1-year follow-up after the salvage hemispherotomy.
Conclusions:
- Endovascular hemispheric destruction may not be an effective substitute for surgical hemispherectomy or hemispherotomy.
- This single-patient case highlights potential limitations of the endovascular approach.
- Further research is needed to establish the safety and efficacy of endovascular hemispherectomy.
