title: Endoscopic corpus callosotomy and hemispherotomy.
abstract: OBJECTIVE
  Corpus callosotomy and hemispherotomy are conventionally performed via a large craniotomy with the aid of a microscope for children with intractable epilepsy. Primary technical considerations include completeness of disconnection and blood loss. The authors describe an endoscopic technique performed through a microcraniotomy for these procedures.
  
  
  METHODS
  Four patients with drop attacks and 2 with intractable seizures related to a neonatal stroke underwent endoscopic complete corpus callosotomy and hemispherotomy, respectively. The surgeries were performed through a 2- to 3-cm precoronal microcraniotomy. Interhemispheric dissection to the corpus callosum was done using the standard technique. Subsequently, the bimanual technique with a suction device mounted on an endoscope was used to perform a complete corpus callosotomy, including interforniceal and anterior commissure disconnection. In patients who had hemispherotomy, the fornix was resected posteriorly and lateral disconnection was done by unroofing the temporal horn. Anteriorly, endoscopic corticectomy was done along the ipsilateral anterior cerebral artery to reach the bifurcation of the internal carotid artery to complete the anterior disconnection. Postoperative MRI and diffusion tensor imaging (DTI) of the brain were performed to confirm complete disconnection.
  
  
  RESULTS
  The procedure was accomplished successfully in all patients, with excellent visualization secured. None of the patients required a blood transfusion. Postoperative MRI and DTI confirmed completeness of the disconnection. Patients who underwent corpus callosotomy had complete resolution of drop attacks at a mean follow-up of 6 months, and patients who underwent hemispherotomy became seizure free.
  
  
  CONCLUSIONS
  Endoscopic corpus callosotomy and hemispherotomy are surgically feasible procedures associated with minimal blood loss, minimal risk, and excellent visualization.
authors.affiliation: Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sood
authors.affiliation: Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Neena I
authors.initials: NI
authors.lastname: Marupudi
authors.affiliation: Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Eishi
authors.initials: E
authors.lastname: Asano
authors.affiliation: Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Abilash
authors.initials: A
authors.lastname: Haridas
authors.affiliation: Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Ham
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003337:Corpus Callosum / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D056324:Diffusion Tensor Imaging; D000069279:Drug Resistant Epilepsy / Q000209:etiology / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D044583:Neuroendoscopy; D012640:Seizures / Q000517:prevention & control; D020521:Stroke / Q000150:complications; D013575:Syncope / Q000150:complications; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACA = anterior cerebral artery; CUSA = Cavitron ultrasonic aspirator; DTI = diffusion tensor imaging; EEG = electroencephalography; MCA = middle cerebral artery; corpus callosotomy; endoscopic surgery; epilepsy; hemispherectomy; hemispherotomy; seizures; technique