Modification of vertical hemispherotomy for refractory epilepsy

Kensuke Kawai, Michiharu Morino, Masaki Iwasaki

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Delalande's vertical hemispherotomy is an innovative evolution of hemispherectomy in minimizing brain resection. We report our modification for this surgical procedure. We modified the original procedure in two aspects for the purpose of less brain resection and confirmation of the complete disconnection. Firstly, all procedures were done via an interhemispheric route instead of a transcortical route. Secondly, we set the anterior disconnection plane as the one that connects the anterior end of the choroidal fissure to the anterior end of the foramen of Monro, instead of the former to the subcallosal area. We applied this modified vertical hemispherotomy to 7 cases. Four cases were children with hemimegalencephaly and other 3 were adults with ulegyric hemisphere. Surgical procedure was completed without complication in all cases. There was no case that required CSF shunting. Seizure outcome was Engel's class I in 6 and class IV in 1. Postoperative MRI revealed complete disconnection of the affected hemisphere in all patients. We reported our modification of vertical hemispherotomy. Although these are minor modifications, they further minimized brain resection and may serve for less invasiveness of procedure and improvement in completeness of disconnection and its confirmation during surgery.

Original languageEnglish
Pages (from-to)124-129
Number of pages6
JournalBrain and Development
Volume36
Issue number2
DOIs
Publication statusPublished - 2014 Feb 1

Keywords

  • Epilepsy
  • Epilepsy surgery
  • Hemispherectomy
  • Hemispherotomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience
  • Clinical Neurology

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