title: The periinsular functional hemispherotomy.
abstract: The surgical treatment of refractory epilepsy has evolved as new innovations have been created. Disconnective procedures such as hemispherectomy have evolved. Presently, hemispherotomy has replaced hemispherectomy to reduce complication rates while maintaining good seizure control. Several disconnective techniques have been described including the Rasmussen, vertical, and lateral approaches. The lateral approach, or periinsular hemispherectomy, was derived from modifications on the functional hemispherectomy and involves removal of the temporal lobe mesial structures, exposure of the atrium via the circular sulcus, internal capsule transection under the central sulcus, intraventricular callosotomy, and frontobasal disconnection. The purpose of this article is to describe and illustrate in detail the anatomy and operative technique for periinsular hemispherotomy, as well as to discuss the nuances and issues involved with this procedure.
authors.affiliation: Department of Neurosurgery, The Methodist Neurological Institute, Houston, Texas 77030, USA. lrcastilla@tmhs.org
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rangel-Castilla
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hwang
authors.forename: George
authors.initials: G
authors.lastname: Al-Shamy
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Curry
mesh_terms: D001921:Brain / Q000601:surgery*; D003337:Corpus Callosum / Q000601:surgery; D004827:Epilepsy / Q000473:pathology / Q000601:surgery*; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D016896:Treatment Outcome