Aventricular hemispherotomy: technical note

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  • 1 Geisinger Neuroscience Institute, Department of Neurosurgery, Danville;
  • 2 Department of Neurosurgery, Children’s Hospital of Philadelphia;
  • 3 Department of Neurosurgery, The University of Pennsylvania, Philadelphia, Pennsylvania;
  • 4 Maria Fareri Children’s Hospital, Westchester Medical Center, Valhalla; and
  • 5 New York Medical College, Valhalla, New York
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Hemispheric disconnection in the form of hemispherectomy or hemispherotomy is the most effective way of treating intractable hemispheric epilepsy. Anatomical hemispherectomy approaches have largely been abandoned in most cases due to a higher risk of superficial hemosiderosis, intraoperative blood loss, hydrocephalus, prolonged hospital stay, and mortality compared to the variety of tissue-sparing hemispherotomy techniques. Disconnective hemispherotomy approaches utilize the lateral ventricle as a key component of the surgical corridor. Without a lateral ventricle, disconnective surgery becomes significantly challenging, typically leading to a hemispherectomy. The authors present the case of a patient with severe hemispheric dysplasia without a lateral ventricle on the pathologic side and detail a novel surgical technique for a prone, occipital interhemispheric, tissue-sparing, purely disconnective aventricular hemispherotomy with an excellent surgical outcome.

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Contributor Notes

Correspondence Cameron Brimley: Geisinger Neuroscience Institute, Danville, PA. cjbrimley@geisinger.edu.

INCLUDE WHEN CITING Published online August 28, 2020; DOI: 10.3171/2020.5.PEDS20247.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Basheer SN, Connolly MB, Lautzenhiser A, Hemispheric surgery in children with refractory epilepsy: seizure outcome, complications, and adaptive function. Epilepsia. 2007;48(1):133140.

    • Search Google Scholar
    • Export Citation
  • 2

    Jonas R, Nguyen S, Hu B, Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes. Neurology. 2004;62(10):17121721.

    • Search Google Scholar
    • Export Citation
  • 3

    Cook SW, Nguyen ST, Hu B, Cerebral hemispherectomy in pediatric patients with epilepsy: comparison of three techniques by pathological substrate in 115 patients. J Neurosurg. 2004;100(2 Suppl Pediatrics):125141.

    • Search Google Scholar
    • Export Citation
  • 4

    Danielpour M, von Koch CS, Ojemann SG, Peacock WJ. Disconnective hemispherectomy. Pediatr Neurosurg. 2001;35(4):169172.

  • 5

    Villemure JG, Rasmussen T. Functional hemispherectomy in children. Neuropediatrics. 1993;24(1):5355.

  • 6

    Daniel RT, Joseph TP, Gnanamuthu C, Chandy MJ. Hemispherotomy for paediatric hemispheric epilepsy. Stereotact Funct Neurosurg. 2001;77(1–4):219222.

    • Search Google Scholar
    • Export Citation
  • 7

    Krynauw RA. Infantile hemiplegia treated by removing one cerebral hemisphere. J Neurol Neurosurg Psychiatry. 1950;13(4):243267.

  • 8

    Bulteau C, Otsuki T, Delalande O. Epilepsy surgery for hemispheric syndromes in infants: hemimegalencepahly and hemispheric cortical dysplasia. Brain Dev. 2013;35(8):742747.

    • Search Google Scholar
    • Export Citation
  • 9

    Battaglia D, Di Rocco C, Iuvone L, Neuro-cognitive development and epilepsy outcome in children with surgically treated hemimegalencephaly. Neuropediatrics. 1999;30(6):307313.

    • Search Google Scholar
    • Export Citation
  • 10

    Kwan A, Ng WH, Otsubo H, Hemispherectomy for the control of intractable epilepsy in childhood: comparison of 2 surgical techniques in a single institution. Neurosurgery. 2010;67(2)(Suppl Operative):429436.

    • Search Google Scholar
    • Export Citation
  • 11

    Laine E, Pruvot P, Osson D. Ultimate results of hemispherectomy in cases of infantile cerebral hemiatrophy productive of epilepsy. Article in French. Neurochirurgie. 1964;10:507522.

    • Search Google Scholar
    • Export Citation
  • 12

    Tinuper P, Andermann F, Villemure JG, Functional hemispherectomy for treatment of epilepsy associated with hemiplegia: rationale, indications, results, and comparison with callosotomy. Ann Neurol. 1988;24(1):2734.

    • Search Google Scholar
    • Export Citation
  • 13

    Villemure JG, Daniel RT. Peri-insular hemispherotomy in paediatric epilepsy. Childs Nerv Syst. 2006;22(8):967981.

  • 14

    Schramm J, Kral T, Clusmann H. Transsylvian keyhole functional hemispherectomy. Neurosurgery. 2001;49(4):891901.

  • 15

    Delalande O, Bulteau C, Dellatolas G, Vertical parasagittal hemispherotomy: surgical procedures and clinical long-term outcomes in a population of 83 children. Neurosurgery. 2007;60(2)(suppl 1):ONS19ONS32.

    • Search Google Scholar
    • Export Citation

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