Peri-insular hemispherotomy: surgical principles and anatomy

Area of Science:

• Neurosurgery
• Neurology
• Neuroanatomy

Background:

• Functional hemispherectomy is a neurosurgical procedure with a long history.
• The peri-insular hemispherotomy is a recent variant, characterized by minimal brain removal.
• Understanding the neuroanatomy of this procedure is crucial for its application and to avoid confusion.

Purpose of the Study:

• To provide a detailed neuroanatomic account of the peri-insular hemispherotomy.
• To clarify the nature and technique of this functional hemispherectomy variant.
• To highlight the advantages of peri-insular hemispherotomy.

Main Methods:

• The procedure involves exposing the insula as a primary surgical landmark.
• Incisions are made along the circular sulcus surrounding the insula.
• A parasagittal callosotomy is performed, and projections through the anterior commissure are disrupted.

Main Results:

• Peri-insular hemispherotomy results in a completely disconnected hemisphere.
• The posterior hippocampus does not require radical removal due to posterior transsection.
• This technique has been successfully performed in 11 patients.

Conclusions:

• Peri-insular hemispherotomy represents a radical hemispheric tractotomy.
• Advantages include shorter operative times and a less severe postoperative course.
• The procedure offers better anatomic preservation of the operated hemisphere, potentially reducing long-term complications.