title: Endoscopy-assisted interhemispheric transcallosal hemispherotomy: preliminary description of a novel technique.
abstract: BACKGROUND
  Various hemispherotomy techniques have been developed to reduce complication rates and achieve the best possible seizure control.
  
  
  OBJECTIVE
  To present a novel and minimally invasive endoscopy-assisted approach to perform this procedure.
  
  
  METHODS
  Endoscopy-assisted interhemispheric transcallosal hemispherotomy was performed in 5 children (April 2013-June 2014). The procedure consisted of performing a small craniotomy (4 × 3 cm) just lateral to midline using a transverse skin incision. After dural opening, the surgery was performed with the assistance of a rigid high-definition endoscope, and bayoneted self-irrigating bipolar forceps and other standard endoscopic instruments. Steps included a complete corpus callosotomy followed by the disconnection of the hemisphere at the level of the basal nuclei and thalamus. The surgeries were performed in a dedicated operating room with intraoperative magnetic resonance imaging and neuronavigation. Intraoperative magnetic resonance imaging confirmed a total disconnection.
  
  
  RESULTS
  The pathologies for which surgeries were performed included sequelae of middle a cerebral artery infarct (n = 2), Rasmussen syndrome (n = 1), and hemimegalencephaly (2). Four patients had an Engel class I and 1 patient had a class II outcome at a mean follow-up of 10.2 months (range, 3-14 months). The mean blood loss was 80 mL, and mean operating time was 220 minutes. There were no complications in this study.
  
  
  CONCLUSIONS
  This study describes a pilot novel technique and the feasibility of performing a minimally invasive, endoscopy-assisted hemispherotomy.
authors.affiliation: *Departments of Neurosurgery, ‡Neuroradiology, and §Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: P Sarat
authors.initials: PS
authors.lastname: Chandra
authors.forename: Nilesh
authors.initials: N
authors.lastname: Kurwale
authors.forename: Ajay
authors.initials: A
authors.lastname: Garg
authors.forename: Rekha
authors.initials: R
authors.lastname: Dwivedi
authors.forename: Shri Vidya
authors.initials: SV
authors.lastname: Malviya
authors.forename: Manjari
authors.initials: M
authors.lastname: Tripathi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods; D005260:Female; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D038361:Neuronavigation; D061646:Operative Time; D012640:Seizures / Q000601:surgery*; D016896:Treatment Outcome