Minimally invasive endoscopic transventricular hemispherotomy for medically intractable epilepsy: a new approach and cadaveric demonstration.
OBJECTIVE
Surgery for medically intractable epilepsy secondary to unihemispheric pathology has evolved from more aggressive hemispherectomy to less aggressive variations of hemispherotomy. The authors propose a novel minimally invasive endoscopic hemispherotomy that should give results comparable to conventional open craniotomy and microsurgery.


METHODS
Endoscopic transventricular hemispherotomy was performed in 5 silicon-injected cadaveric heads in the authors' minimally invasive neurosurgery laboratory. The lateral ventricle was accessed endoscopically through a frontal and occipital bur hole. White matter disconnections were performed to unroof the temporal horn and to disconnect the frontobasal region, corpus callosum, and fornix.


RESULTS
Using an endoscopic transventricular approach, all white matter disconnections were successfully performed in all 5 cadavers.


CONCLUSIONS
The authors have demonstrated the feasibility of endoscopic transventricular hemispherotomy in a cadaveric model. The technique is simple and could be useful in a subgroup of patients with parenchymal volume loss and ventriculomegaly.
Division of Pediatric Neurosurgery, Rainbow Babies and Children's Hospital, The Neurological Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Biji
B
Bahuleyan
Sunil
S
Manjila
Shenandoah
S
Robinson
Alan R
AR
Cohen
D002102:Cadaver; D002540:Cerebral Cortex / Q000098:blood supply / Q000601:surgery; D002550:Cerebral Veins / Q000601:surgery; D003337:Corpus Callosum / Q000098:blood supply / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D004827:Epilepsy / Q000601:surgery*; D005240:Feasibility Studies; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D020547:Lateral Ventricles / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010841:Pia Mater / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D012825:Silicon
D012825:Silicon