Interhemispheric Vertical Hemispherotomy: A Single Center Experience.
OBJECTIVE
Hemispheric epileptogenic lesions such as hemimegalencephaly often manifest as intractable epilepsy in early infancy. Hemispherotomy is the treatment of choice for controlling intractable hemispheric epilepsy. Less invasive procedures are desirable for surgery on infants with low body weight. This study compared our experience with interhemispheric vertical hemispherotomy (IVH) and peri-insular lateral hemispherotomy (PIH).


METHODS
Thirteen consecutive patients underwent hemispherotomy for treatment of intractable epilepsy in our institution between 2001 and 2012. The etiology of epilepsy included hemimegalencephaly in 7 patients and cortical dysplasia in 3. PIH was performed on the first 5 patients and IVH on the last 8 patients. In the latter procedure, complete section of the corpus callosum was first performed via the interhemispheric approach. After removing part of the cingulate gyrus, section of the descending fibers was performed anterolaterally to the thalamus. Clinical characteristics, duration of operation and amount of blood transfusion were compared between the PIH and IVH groups.


RESULTS
There was no difference in age at surgery, body weight and age of epilepsy onset between the two groups. No surgery-related death was observed. No patients required shunt operation. One patient who underwent IVH required reoperation for incomplete disconnection. The amount of intraoperative blood transfusion was smaller and the total duration of operation was shorter in the IVH group than in the PIH group.


CONCLUSIONS
The interhemispheric approach minimizes cortical resection and may be less invasive than PIH. IVH is advantageous for treating infants with low body weight.
Masaki
M
Iwasaki
Mitsugu
M
Uematsu
Shin-Ichiro
S
Osawa
Yoshiteru
Y
Shimoda
Kazutaka
K
Jin
Nobukazu
N
Nakasato
Teiji
T
Tominaga
D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000209:etiology / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy / Q000379:methods* / Q000592:standards; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome